David Thompson, DNSc, MS, RN Jill Marsteller, PhD, MPP Conflict Resolution What is Conflict? вЂў Perception of mutual interference вЂў A process that begins when goals of one party are frustrated by another вЂў Requires interdependence/interaction Views of Conflict вЂў Conflict Good (interactionist view) вЂў Conflict Natural (human relations view) вЂў Conflict Bad (traditional view) вЂў Conflict must be managed Sources of Conflict вЂў Conflict arises from resource scarcity вЂў Goals of parties are incompatible вЂў Other structural factors (size, routinization, specialization, reward systems) вЂў Conflicting perceptions, ideas, or beliefs вЂў Differences between people вЂў Conflicting thoughts/needs within an individual вЂў Lack of communication (maybe) Types of Conflict вЂ“ Task Content conflict (differing opinions related to the task) G вЂ“ Emotional or Relationship conflict (interpersonal conflict--dislike, negative emotions) B вЂ“ Administrative or Process conflict (disagreement on how to get the task completedвЂ”e.g., duties, decision-making technique) B to N Goal of Conflict Resolution вЂў Confront problems, communicate openly and respectfully with someone of opposing opinion to provide optimal patient care. Why address Conflict Resolution? вЂў Inevitable in dynamic environments вЂў Conflict can lead to feelings of powerlessness вЂў Conflict can cause anyone especially subordinates to view administrators, attending physicians as adversaries and creates conflict and divided loyalties in the workplace Assertion IS Being appropriately assertive means: вЂў Organized in thought and communication вЂў Technically and socially competent вЂў Disavowing perfection while looking for clarification / common understanding вЂў Being owned by the entire team (this is not just a вЂњsubordinateвЂќ skill-set, and it must be valued by the receiver to work) Assertion вЂ“Is NOT вЂў NOT вЂў Aggressive вЂў Hostile вЂў Confrontational вЂў Ambiguous вЂў Demeaning вЂў Condescending The Assertion Model вЂў Model to guide and improve assertion in the interest of patient safety Helpful Hints in Applying The Assertion Model вЂў Focus on the common goal: quality care, the welfare of the patient, safety вЂ“ itвЂ™s hard to disagree with safe, high quality care вЂў Avoid the issue of whoвЂ™s right and whoвЂ™s wrong вЂњPatient Centered care вЂ“ concentrate on doing the right thingвЂќ вЂў De-personalize the conversation вЂў Actively avoid being perceived as judgmental вЂў Be hard on the problem, not the people Strategies for Conflict Resolution 1. WithdrawalвЂ”little or no significance to either party (lose-lose) 2. ForcingвЂ”force outcome regardless of the desire of one party (win-lose) 3. ConciliationвЂ”giving in to preserve relationship with other party (lose-win) 4. CompromiseвЂ”concerned with both outcome and relationship (?-?) 5. CONFRONTATIONвЂ”meet the problem head on (win-win) Confrontation is an Assertive means of Conflict Resolution вЂў Respectful negotiation вЂў Effective Conflict resolution is what is right not who is right. вЂў Never Aggressive. Use to explain perspectives. If handled appropriately may be an opportunity to educate the other party involved. Two Attempt Rule: вЂў Using the elements of assertion make 2 attempts to reach a common goal. вЂў If your viewpoint is disregarded, Traditionally continue up the chain of command or вЂњescalateвЂќ to achieve resolution. вЂў Charge nurse вЂў Nurse Manager вЂў Fellow вЂў Attending Conservative Response вЂў Non-confrontational method to gain agreement among 2 or more team members вЂў Used to ensure disagreement does not escalate to confrontation by seeking input and advice from another team member or outside consultant DESC Script What is it? A structured, assertive, communication approach for managing and resolving conflict. D Describe the specific situation E Express your concerns about the action S Suggest other alternatives C Consequences should be stated Ultimately, consensus shall be reached. When to use it? Whenever you have a personal conflict with another health team member that threatens your ability to perform your job well Key Points Have timely discussion DESC Example вЂў D- When you scream at me in front of my co-workers about the delay in care, youвЂ™re making it personal. вЂў E- This reduces my credibility with the patients and undermines my authority with staff. I feel you donвЂ™t respect me. вЂў S- If you are upset about delays or other patient care issues, pull me aside and I will address your concerns. вЂў C- If your outbursts continue we wonвЂ™t have a working relationship, and patient care will suffer. LEEN--A Model for Conflict Resolution L- Listen E- Empathize E- Explain N- Negotiate Conflict with Patients/Families L- Can you help me understand why you are upset. E- That is understandable, I can see why you are upset. E- The reason we wanted to do this was becauseвЂ” N- LetвЂ™s agree on a path forward. Conflict with Clinicians вЂў L- Can you help me understand how you see the situation, how you are weighing the risks and benefits. вЂў E- I can see how you see it that way. вЂў E- Let me explain how I see things. вЂў N- LetвЂ™s put the patient first and agree on a plan.