conflict resolution 101: prevention and treatment! · 2020-06-11 · conflict resolution 101:...

Conflict Resolution 101: Prevention and Treatment!

Ndidi Unaka, MD Sue Poynter, MD, MEd

Melissa Klein, MD, MEd Jennifer O’Toole, ME, MEd

Javier Gonzalez del Rey, MD, MEd

Disclosure of Commercial Relationship(s)

• Ndidi Unaka, MD • Sue Poynter, MD, MEd • Melissa Klein, MD, MEd • Jennifer O’Toole, MD, MEd • Javier Gonzalez del Rey, MD, MEd

NO FINANCIAL COI TO DISCLOSE

Your Goals…?

Today’s Agenda… • What is conflict? • How do we “react or respond” to conflict? • How we communicate? • How can we approach conflict? • Team vs. Groups • Negotiation • Win – Win “rule”

So… • What is conflict? • How do we “react or respond” to conflict? • How we communicate? • How can we approach conflict? • Team vs. Groups • Negotiation • Win – Win “rule”

So… • What is conflict? • How do we “react or respond” to conflict? • How we communicate? • How can we approach conflict? • Team vs. Groups • Negotiation • Win – Win “rule”

Definitions of Conflict

• To come into collision or disagreement; be contradictory, at variance, or in opposition; clash: “The account of one eyewitness conflicted with that of the other”

• To fight or contend; do battle. • A state of disharmony between incompatible persons,

ideas or interests; a clash.

Oxford English Dictionary

“Conflict is a form of interaction among parties that differ in interest,

perceptions, and preferences.”

Osland, J.S., Kolb, D. A., & Rubin, I. M., 2001

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Negative Aspects of Conflict • Conflict is often regarded as negative, destructive

and undesirable. • Conflict can:

– Hinder communication – Interfere with relationships – Increase problems – Erect barriers

Positive Aspects of Conflict

• Conflict can also be creative and constructive. • Conflict can:

– Promote new ideas – Strengthen relationships – Stimulate individual growth – Facilitate the examination of problems – Encourage interpersonal communication

So… • What is conflict? • How do we “react or respond” to conflict? • How we communicate? • How can we approach conflict? • Team vs. Groups • Negotiation • Win – Win “rule”

Conventional Responses to Conflict

• Conventional responses could appear to address the conflict but may not be effective: – Withdrawal, staying silent – Denial – Dominance – Suppression – Placate

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So… • What is conflict? • How do we “react or respond” to conflict? • How we communicate? • How can we approach conflict? • Team vs. Groups • Negotiation • Win – Win “rule”

Your Observations…

Communication 101

• Verbal & Non Verbal • Distances

– Intimate Zone – Personal Zone – Social Zone – Reactionary Gap

• Styles – Transactional Analysis – Critical Parents – Nurturing Parents – Adult Ego State – Adopted Child – Free Child

Communication 101

• Non Verbal & Verbal • Distances

– Intimate Zone – Personal Zone – Social Zone – Reactionary Gap

• Styles – Transactional Analysis – Critical Parents – Nurturing Parents – Adult Ego State – Adopted Child – Free Child

How we communicate?

• Body language Facial expression and body language (55%) • Tone The way the words are said (38%) • Words Words that are spoken (7%) (Mehrabian A. (1971) Silent messages)

“I intubated that patient”

“I intubated that patient”

“I intubated that patient”

“I intubated that patient”

Non Verbal… Tone?

Communication 101

• Non Verbal & Verbal • Distances

– Intimate / Personal Zone – Social Zone – Reactionary Gap

• Styles – Transactional Analysis – Critical Parents – Nurturing Parents – Adult Ego State – Adopted Child – Free Child

Cultural Awareness • Not all cultures have the same body language. For example, some

people will not make eye contact when talking and some people will not shake hands as touching is not accepted.

• Invading someone's personal space is accepted and common practice in some cultures. Some females may not even communicate without a chaperone or a husband present.

• Being aware of the signals we give out is an important place to start. It is also important to take the time to find out about a person’s cultural preferences.

“Proxemics”

PUBLIC ZONE (10 ft +)

Furthest distance at which people can communicate effectively

Subjects entering or remaining within this area cause no anxiety or concern

“Proxemics”

SOCIAL ZONE (18 ins to 10 ft)

Distance at which people can talk comfortably without perceiving any

threat

“Proxemics”

INTIMATE ZONE (0 to 18 ins)

Area reserved for only close relatives and friends

At this distance chemical changes take place in the body.

People we know and feel comfortable with (friends,

colleagues).

“Proxemics”

PERSONAL ZONE (18 inches to 4 foot)

Reactionary gap? • The distance we should adopt when dealing with conflict • It is the distance between the extremities of your reach

and that of your opponent’s (including any weapons!!)

Changing the “Tone”

• “V” System

• Table Design

Communication 101

• Non Verbal & Verbal • Distances

– Intimate / Personal Zone – Social Zone – Reactionary Gap

• Styles – Transactional Analysis – Critical Parents – Nurturing Parents – Adult Ego State – Adapted Child – Free Child

Attitude and Behavior Cycles

“ The way you see them is the way you treat them and the way you treat them is the way they often become”

Zig Ziglar

Betari’s Box

Patterns of Behavior

Remember, we don’t know the story of THAT person, that day!

COMPLIANCE

VERBAL RESISTANCE / GESTURES

PASSIVE RESISTANCE

ACTIVE RESISTANCE

AGGRESSIVE RESISTANCE

SERIOUS AGGRAVATED AGGRESSION

Conflict Escalation Model

Danger

Signs

Warning

Signs

IMPACT FACTORS

COMPLIANCE

VERBAL RESISTANCE / GESTURES

PASSIVE RESISTANCE

ACTIVE RESISTANCE

AGGRESSIVE RESISTANCE

SERIOUS AGGRAVATED AGGRESSION

Conflict Escalation Model

Danger

Signs

Warning

Signs

Impact Factors

PEOPLE Sex, age, size, build, skills, mental state, numbers

present, physical or mental tiredness. OBJECTS Alcohol, drugs, potential weapons, items of

value, time of the day, animals. PLACES Excessive noise, safe exits, room layout, public or

private premises, slip/trip hazards, imminent danger.

So… • What is conflict? • How do we “react or respond” to conflict? • How we communicate? • How can we approach conflict? • Team vs. Groups • Negotiation • Win – Win “rule”

Communication Models • PEACE model can help prevent communication

breakdowns before they escalate:

P = PLAN, PREPARE E = ENGAGE, EXPLAIN A = ACCOUNT FOR ACTIONS C = CLOSURE E = EVALUATE

Communication Models • LEAPS can help you defuse and resolve a potentially difficult

situation • Helps to bring a sense of professionalism when applied in the

workplace L = LISTEN E = EMPATHIZE A =ASK QUESTIONS P = PARAPHRASE S = SUMMARISE Dr. G. J. Thompson “Verbal Judo”

Let’s Practice… • An 8 year old with chronic abdominal pain (6 months) is referred to the ED for work up.

There is a history of multiple office visits for pain the past 2-3 weeks. There is no weight loss, fever or other constitutional issues. VS are normal and the child is subdued but appears well. The family is stressed. After your assessment of the child – you do not find any significant history or PE findings that concern you. In the referral it states they are looking for a work up and for GI to see the patient today in the ED.

• What are options for the conversations to have with family and referring MD to mitigate issues?

Let’s Practice… • A fellow calls for a surgical consult on a patient with an abnormal exam / concerning for

surgical abdomen. Surgical resident arrives and you noticed that he / she is very condescending with the resident and makes several inappropriate statements about your service.

• Discuss some options to advocate for the resident / your practice.

So… • What is conflict? • How do we “react or respond” to conflict? • How we communicate? • How can we approach conflict? • Team vs. Groups • Negotiation • Win – Win “rule”

Groups, Teams and Organizational Effectiveness

• Team – A group whose members work intensely with each

other to achieve a specific, common goal or objective.

– All teams are groups but not all groups are teams. • Teams often are difficult to form. • It takes time for members to learn how to work together.

Groups, Teams and Organizational Effectiveness

• Group – Two or more people who

interact with each other to accomplish certain goals or meet certain needs.

The Stages of Group Development

15-46 Figure 15.4

The Stages of Group Development

15-47 Figure 15.4

Any “Tricks”… for “Group Controllers”?

• Ranking • Anonymous votes • Redirect questions • Partner discussions…

“Negotiations”: Compromise vs. Win-Win

Let’s think for a second…

• There are two people in a kitchen. There is only one orange left and both of them want it. What would you expect as the solution?

• Compromise is one option. They might cut it in half and each gets half.

Did they get what they wanted…

• Let’s assume that’s what they do. One person now goes to the juicer and starts squeezing a rather too small glass of orange juice.

• The other, with some difficulty, begins to grate the rind of the orange to flavor a cake.

A win/win approach involves:

• Going back to underlying needs • Recognizing individual differences • Adapting positions in light of

shared information and attitudes • Attacking the problem, not the

people

Braham’s Negotiation Tips

• Know Thyself • Do Your Homework • Practice Double and Triple

Think • Build Trust • Develop External Listening • Move Beyond Positions

• Own Your Power • Know Your BATNA

– (Best Alternative To a Negotiated Agreement)

• Know What a Win Is • Enjoy the Process

Skills Techniques and Strategies for Effective Negotiations: Tips from Barbara Braham (2004)

Fight or Flight

BEWARE! “The blood supply to the frontal parts of the brain,

responsible for higher levels of reasoning is reduced, while the supply to the more primitive parts, near the brain stem, is increased. These parts are responsible for automatic, instinctive, impulsive decision making and behavior.”

You may do something you may thoroughly regret later!

In Summary…

How we communicate?

• Body language Facial expression and body language (55%) • Tone The way the words are said (38%) • Words Words that are spoken (7%) (Mehrabian A. (1971) Silent messages)

Communication Models • PEACE model can help prevent communication

breakdowns before they escalate:

P = PLAN, PREPARE E = ENGAGE, EXPLAIN A = ACCOUNT FOR ACTIONS C = CLOSURE E = EVALUATE

Communication Models • LEAPS can help you defuse and resolve a potentially difficult

situation • Helps to bring a sense of professionalism when applied in the

workplace L = LISTEN E = EMPATHIZE A =ASK QUESTIONS P = PARAPHRASE S = SUMMARISE Dr. G. J. Thompson “Verbal Judo”

Did they get what they wanted…

One Word about today…

“We must all learn to live together as brothers or we will perish together as fools. We are tied

together in the single garment of destiny, caught in an inescapable network of mutuality. And whatever

affects one directly affects all indirectly. For some strategic reason, I can never be what I ought to be

until you are what you ought to be.”