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Andrea M. Landis, PhD, RN UW LEAH November 30 th, 2012
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Conflict: Introduction Definition Fight, battle, war
Antagonistic state or action (as of divergent ideas, interest, or
persons) Mental struggle resulting from incompatible or opposing
needs, drives, wishes, or external or internal demands Within or
between Where can conflict occur?
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Conflict Conflict can arises from: Different goals Differing
sets of information Differing perceptions Horizontal violence
Perception that levels of appreciation are not equal
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Conflict GOAL: Advance collaborative practice and conflict
competence among health professionals and industry leaders who are
responsible for the following: Improving patient safety Achieving
accountable care Developing healthy work environments Creating a
resilient workforce
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Part 1: Perspectives in Conflict
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A Nobodys in Charge World Shared responsibility for the same
programs & goals UW Shared Governance Integrated and networked
organizations require power sharing Interdependence required to get
things done places limits on individual authority Disagreements
& conflicts are not uncommon
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How do you view conflict? A battle to be won? A problem to be
solved? A danger? An opportunity? Something to be avoided at all
costs?
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Perspectives of Conflict BehavioralInevitableControl
TraditionalDestructiveEliminate InteractionInevitableManage
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Common Reactions to Conflict FIGHT FLIGHT Confronting
Sabotaging Over-reacting Bypassing Avoiding Under-reacting
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Consider your Shadow Side What are your behavioral tendencies
when you are Angry? Exasperated? Tired? Stressed? In a bad mood?
Can you recognize when you are
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Dealing with your Emotions Take your emotional temperature
Resist your first negative reaction Consider a time-out Get the
facts Get another perspective Vent to someone else If time permits,
plan your approach
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Dealing with their emotions Allow them to vent Use restatement;
dont raise your voice Accept their feelings as legitimate Help them
save-face work towards a win-win Dont refute their statements yet!
Dont be afraid of silence Dont be afraid to say You might be
right
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Reduce Tension Through Listening Listen to understand Listen
actively (in an involved way) Listen with your eyes Dont tune out
messages you think youve heard before Listen first THEN plan your
next comment
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Part 2: Strategies for Navigating & Resolving Conflict
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Conflict Management Comprehensive term indicating the range of
attitudes and behaviors individuals, groups, and organizations
manifest in dealing with conflict. Always present Range from
denial, suppression, and retaliation to creative proactive
programs
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Alternative Dispute Resolution (ADR) (Gerardi, 2010) Provides
an array of processes designed to achieve that goal, negotiation,
mediation, and arbitration for health care providers Developed body
of literature documenting best practices and empirical findings to
guide both students and practitioners of ADR
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ADR continued Came to age in the 1990s Restructuring of health
care organizations Reductions in the number of acute care nurses;
shortened length of stay that increased patient acuity concurrent
with increased emphasis on patient safety. IOM report (1999) To Err
is Human: Building a Safer Health Care System Documenting the
magnitude and severity of preventable medical errors (adverse
events) Further catalyzed the patient safety movement Creation of
patient safety organizations that generated substantial data sets
Documented that problematic relationships among providers was a
primary causal factor in adverse events.
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ADR continued ADR practitioners considered health care the last
frontier persistently resistant to self-examination and action that
might enhance existing conflict management practices. Reasons for
resistance: Health care environments are complex adaptive systems;
Widespread inequalities and imbalances in power; Includes numerous
subcultures with significant variance; Difficulty determining who
should be at the table History of litigation pattern of conflict
aversiveness, avoidance, suppression, and blame.
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Thomas-Kilmann Conflict Mode Instrument 5 potential responses
to conflict: Avoidance Compromise Accommodation Competition
Collaboration* * Both high cooperativeness and assertiveness and
provides long-term solution to a conflict
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Conflict Engagement Part of ADR De-emphasizes conflict
resolution and shifts the focus to competent engagement Blueprint
for collaboration
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Silence Kills AACN (2005) sponsored a landmark study (1,700
nurses, physicians, clinical-care staff, and administrators)
identifying conversations especially difficult for health care
professionals, at the same time essential for people in healthcare
to master including: 1. Broken rules 2. Mistakes 3. Lack of support
4. Incompetence 5. Poor teamwork 6. Disrespect 7. Micromanagement
Concurrently developed related standards for health work
environments
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Silent Kills Majority of healthcare workers regularly see some
of their colleagues break rules, make mistakes, fail to offer
support, or appear critically incompetent; < 10% say anything
This study explored the frequency with which people experience
these kinds of concerns and the consequences of their failure to
speak up when they do Online survey of nurses 53% respondents
reported that conflict while on the job was common This study
suggests that creating a culture where healthcare workers speak up
before problems occur is a vital part of the solution.
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Every utterance functions on two levels Level 1: Communicates
ideas Level 2: Negotiates relationships
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Develop a Negotiation Mindset What is your personal goal in
managing conflict more effectively?
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Two Primary Concerns for Every Negotiator Achieving the best
outcome and agreement Maintaining and building the
relationship
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Diagnosing Disagreement 1. What is the nature of the
difference? 1. Facts 2. Goals 3. Methods 4. Values 2. What factors
may underlie these differences? 1. Information: differences based
on different set of facts 2. Perceptual: parties bring different
sets of biases and beliefs 3. Role: position and status of parties
can place constraints on the discussion
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Underlying Causal Factors Information Factors Disagreement is
based on different facts Do the disagreeing parties have access to
the same info? Perceptual Factors Different set of biases and
beliefs Do the disagreeing parties perceive the shared information
differently? Role Factors Disagreement is influenced by the
position or status of the parties in the organization and/or
society How much are the disagreeing parties influenced by their
position or role in the organization?
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Plan Your Approach Know your goal for resolving the
disagreement: what do you want? Define the problem/issue for
yourself Consider how the other party defines the
problem/issue
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Execute Your Approach State the problem/issue Set a positive
tone for the conversation Explore each others needs Start with, How
can we. Ask open-ended questions Dont include solutions in your
questions Watch your listen/talk radio Observe non-verbal cues
Avoid interpreting motives Identify possible options Select the
best one Reach agreement
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Handling Disagreements Without Resolving Them Listen but dont
argue Agree to disagree Accept their feelings, not points Focus on
something else
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Dealing effectively with differences depends on. Desire to
resolve the differences Ability to diagnose and understand the
differences Awareness and ability to use the appropriate behavioral
responses Ability to deal with your own feelings especially those
that might limit your effectiveness
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Carefronting (Kupperschmidt,2008) How to manage conflict when
individuals have divergent values, beliefs, and attitudes Goal is
to guide individuals and/or teams to get past their day to day
problems, conflicts, and communication issues Augsburger (1981)
refers to the skill of caring enough about oneself, others, and
desired goals to confront inappropriate behavior responsibly while
offering the opportunity for change.
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Carefronting Act of inviting, not demanding, another to change
and a creative way through conflict, a way to unite caring and
candor in relationships Key tenets: Truthing it: A simplified
speech style Owning anger: Let both your faces show Inviting
change: Careful confrontation Giving trust: A two-way venture
Ending blame: Forget whose fault the conflict is Getting unstuck:
The freedom to change Peacemaking: Getting together again
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TenetDefinitionExamples Truthing itWillingness and ability to
listen deeply, empathetically, and accurately to assure
understanding of others point of view I want to hear you
accurately; I want to share my feelings and attitudes with you; I
want to be heard Owning Anger Anger is both a positive,
self-affirming emotion and a demand; When one feels
ignored/rejected the normal response is anger I am a person of
worth, I demand that you recognize and respect me; Each person is
responsible for choosing how they respond and react to others when
conflict occurs Inviting change Focus on feedback on the behavior,
not the person; on observations, not conclusions; on descriptions,
not judgments; on ideas and alternatives, not on advice and
answers. Think caringly, gently, constructively, and clearly
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TenetDefinitionExample Giving Trust Trust grounded in authentic
self- disclosure; Trust confronts openly, frankly, respectfully,
and responsibly, trusting that the other person will assume his/her
responsibility to be equally honest and frank Release demands and
accepts apologies Ending Blame Confrontation that endeavors to
place blame inevitably evokes resistance and resentment. Ends the
blame game, leading to real questions Where do we go from here?
When do we discuss the conflict? If not now, when? Getting unstuck
Owning responsibility for ones part in the conflict and refusing to
waste time in assigning blame Accepting accountability for
behavioral changes that accept responsibility for the present
conflict and focusing on what can be shared. Peace- making Truly
present in conflict situations, listening, and caring for all
stakeholders; care enough to confront and drop the demands of the
past Value others; those who have rediscovered that the values that
shape their decisions must be lasting values consistent with the
values of the profession
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Carefronting Alternative to traditional conflict resolution
Useful in healthcare environments where team synergy and
interdependence are required for high quality and safe patient care
(think interdisciplinary) Development of trust among team members
on teams begins with communication in relationships, especially,
when there is disagreements Relationships live within the context
of conversations that individuals have or do not have with one
another