Conflict Resolution. A Core Leadership Attribute Seminar on Negotiation

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Conflict Resolution

A Core Leadership Attribute Seminar on Negotiation

Created By:

Gus M. Garmel, MD, FACEP, FAAEM Clinical Professor, Department of Surgery Co-Program Director, Stanford/Kaiser Emergency Medicine Residency Stanford University, Palo Alto, California

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Negotiation – Conflict Resolution 4

Course of Conflict

Stalemate

Communication Failures & Conflict

Escalation Negotiation & Conflict Resolution Time Int en sity

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Outline

• Definitions & Relevance

• Types & Factors of Conflict

• Conflict Resolution

– Keys & Principles – Barriers

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Conflict

• Any situation where incompatible activities, feelings, or intentions occur together.

• A competitive or opposing action of incompatibles; an antagonistic state of action (divergent ideas, interests, or persons).

• Mental struggle resulting from incompatible or opposing needs, drives, wishes, or

external or internal demands.

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Conflict Resolution

• A range of processes aimed at alleviating, eliminating, or resolving conflict or its

sources.

• The methods and process of negotiation, arbitration, and institution building which promote the peaceful ending of social

conflict and war.

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Negotiation

• A dialogue intended to:

– Resolve disputes

– Agree upon course of action – Bargain for advantages

– Satisfy various interests

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Relevance

Model of the Clinical Practice of Emergency Medicine*

COMMUNICATION AND INTERPERSONAL SKILLS ISSUES

Complaint Management Conflict Resolution

Interdepartmental and Medical Staff Relations Team Building

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Relevance

- For Emergency Medicine

• Conflict is often

outcomes-driven

and

not

process-driven

• Physicians are typically goal-oriented

– EPs want to win & desire control

– EPs focus on immediate outcomes (want things to happen now)

• great for patients

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Relevance

- For Emergency Medicine

• Salaries & Schedules

• Positions & promotions

• Patient care

• Interpersonal interactions

• Medical legal protection

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Relevance

- Example

An emergency RN will not perform a

certain task you have requested

because she doesn’t feel it is

necessary. You are a good clinician,

but you have a reputation in your ED

as being “difficult.”

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Relevance

- Example

76 year old female who doesn’t feel well

is brought to the ED by her adult son.

Her entire work-up is negative, but

the son wants her admitted, despite

no medical nor social indication.

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Relevance

- Example

A consultant doesn’t think that he needs

to see the patient you are calling about

at 1 AM. You don’t know this

individual, but you’ve heard he is not

well-liked by your colleagues.

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Why Do We Conflict?

• Personal differences

• Information deficiency

• Role incompatibility

• Environmental stress

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Types of Conflict

• Intrapersonal

• Interpersonal

• Intragroup

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Types

of Conflict

- Intrapersonal conflict

• Conflict within

• Example

– Conflict in dealing

with a particular type of patient

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Types of Conflict

- Intragroup conflict

• Conflict between individual group

members

• Example

– Your colleague always grabs the sickest patients and major resuscitations

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Types of Conflict

- Intergroup conflict

• Conflict between 2 groups of people

• Example

– Who performs the ED thoracotomy in a trauma resuscitation (EM vs. Surgery)

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Types

of Conflict

- Interpersonal conflict

• Conflict between 2 persons

• Example

– Conflict with a patient’s family member or nurse

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Factors in Conflict

• Personal Attributes

• Gender

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Factors in Conflict

- Personal Attributes

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Factors in Conflict

- Personal Attributes

• Keirsey’s 16 Categories

ARTISAN GUARDIAN IDEALIST RATIONAL

Promoter Supervisor Teacher Field marshal Crafter Inspector Counselor Mastermind Performer Provider Champion Inventor

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Factors in Conflict

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Factors in Conflict

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Factors in Conflict

- Ethnicity & Culture

• Language

• Behavior nuances

• Negotiation style

• Passion

• Tempo

• Culture

• Custom

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Conflict Resolution

- The keys & principles

• Gain insight

• Truth always

• Seek wisdom

• Never criticize

• Offer assistance

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Conflict Resolution

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Conflict Resolution

- The keys & principles

* Garmel GM. Conflict Resolution in EM. In Adams Emergency Medicine (Elsevier), 2008. Adapted from Ahuja J, Marshall P. Conflict in the

emergency department: Retreat in order to advance. Can J Emerg Med

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Conflict Resolution

- Barriers

• Preformed judgments

• Poor communication skills

• Cultural/gender barriers

• Lack of understanding of both sides

• Not possessing the right skill set

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non-Negotiation – Conflict Resolution 38

Conflict Resolution

- Barriers

• Cynicism

• Criticism

• Comparing

• Competing

• Complaining

• Contending

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Conflict Resolution

- Pearls

• Plan ahead for all possible outcomes

• Know related policies &procedures

• Respect your primary responsibilities

& obligations

• Seek to Gain consensus, not to prove a

point

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The Art of Communication

Effective Communication

is

essential

for

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The Art of Communication

• Avoid (Obvious) Pitfalls

– I’m the attending!

– Because I said so!

– I’m right! (or, You’re wrong!) – My way is the only way!

– You’re just a … nurse/tech/NP/internist! – You’re an XXXXX !

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The Art of Communication

Strive to find mutual understandings

– I can see your point, but I don’t feel you are considering mine.

– Let’s discuss this a bit more from the patient’s perspective.

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The Art of Communication

- Effective vs. Ineffective

Effective

• Smile • Eye contact • Avoiding emotion • Active listening • Concentration • Attention • Focused

Ineffective

• Snarl

• Arms across chest

• Finger pointing

• Pacing

• Distracted

• Inattention

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The Art of Communication

Negotiation is the art of

letting them have your way.

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The Art of Communication

Let us never negotiate out of fear

-But let us never fear to negotiate.

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Process of Negotiation

- The definition revisited

• Negotiation is a dialogue intended to:

– Resolve disputes

– Agree upon course of action – Bargain for advantages

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Process of Negotiation

- Objectives

• Mutually satisfactory structure

• Executed agreement

• Lasting and mutually beneficial

relationship

• Comfort with process and outcome

• Accounts for feelings

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Process of Negotiation

- Outcomes Win/Lose Win/Win Lose/Win Lose/Lose I Win You Win You Lose

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Process of Negotiation

- Steps to success

• Have a plan

• Broad to narrow

• Actively listen & learn

• Take notes

• Unbundle issues

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Process of Negotiation

- Timeline

• Initial - assess situation, gather information (from multiple sources), establish trust,

build the relationship

• Middle - patience, gather facts, consider counteroffers, mutual concessions

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Process of Negotiation

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Process of Negotiation

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Process of Negotiation

- Principled negotiation • An interest-based approach to negotiation focusing primarily on conflict management and conflict resolution. • Uses an integrative

approach to find a mutually shared outcome

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Process of Negotiation

Focus on the issues,

not positions

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Process of Negotiation

- BATNA?

• B

est

A

lternative

T

o a

N

egotiated

A

greement

(BATNA)

• What will happen if

negotiations fail?

– Your course of action – Their likely course of

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Process of Negotiation

- BATNA

• Develop your BATNA and attempt to determine theirs

• Only reveal your BATNA if it is better than

theirs

• Consider accepting terms when their proposal is better than your BATNA

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Process of Negotiation

- Barriers

• Emotions

– Fear & Anger

• Difficult Questions

• Difficult Personalities

• Complex Situations

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Process of Negotiation

- Barriers: Emotions

Fear is like fire. If controlled it will help you; if uncontrolled, it will rise up and destroy you. Men's actions depend to a great

extent upon fear. We do things either

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Process of Negotiation

- Barriers: Difficult Questions

• Defer

• Deflect

• Delay

• Decline

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Process of Negotiation

- Barriers: Difficult Personalities

• Often unavoidable

• May result in or escalate conflict

• Individual may have a position of

authority

• Strategies

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Process of Negotiation

- Barriers: Complex Situations

• Repeat over time

• Multi-issue

• Multi-party

• Intangible factors

• Intra-organizational

• Tangible factors

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Process of Negotiation

- Pearls

• Find (and point out) common ground

• Understand your counterpart’s

perspective

• Work to shape their decision

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Process of Negotiation

- When You Need Help

• Seek assistance from a trusted

colleague or supervisor

• Refer to hospital bylaws and policies

• Contact Human Resources

• Call in mediator (or arbitrator)

• Walk away

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Summary Points

• Conflict is inevitable • Do your homework

• Identify personal attributes • Avoid emotional investment • Listen carefully to what is said • Don’t burn bridges

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Final Remark

Successful conflict resolution can be

challenging because it has so many

elements and possibilities, yet it

undeniably plays a large role in an

emergency physician’s daily and

career activities.

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National Residency Leadership Curriculum

Questions?

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National Residency Leadership Curriculum

Special Thanks!

Funded By:

An American College of Emergency Physicians Chapter Grant

Endorsed By:

American College of Emergency Physicians Emergency Medicine Council of Residency Directors Emergency Medicine Resident’s Association Society for Academic Emergency Medicine

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National Residency Leadership Curriculum

Special Thanks!

Senior Editors:

Stephen Wolf, MD, FACEP Andrew French, MD Matthew Mendenhall, MD, MPH

Tenet Editors:

Britney Anderson, MD Barbara Blok, MD, FACEP Jeffrey Druck, MD, FACEP

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National Residency Leadership Curriculum

Thank You!

For More Information Please Visit:

www.DenverEM.org www.CoACEP.com