dealing with conflict in health care: the next dimension of team training scott ellner, do, mph,...
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Dealing with Conflict in Health Care:The Next Dimension of Team Training
Scott Ellner, DO, MPH, FACS
Vice Chairman of SurgerySaint Francis Hospital and Medical Center
Hartford, ConnecticutJUNE 27, 2013
Blame and Shame
Identify Culture
• Communication
• Behavior
• Rituals
• Tolerance
OR Safety Attitudes Questionnaire - SAQ
12. In the OR, it is difficult to discuss errors. 1 2 3 4 5
SAQ Participants
N=165
Dimensions and Service Line Comparison
2009:
Service Line (responses)/Dimension (AHRQ Benchmark)
Hospital Handoffs and Transitions (38)
Staffing (49)
Feedback and Communication About Error (60)
Teamwork WITHIN units (77)
Manager Expectations & Actions P romoting Safety (72)
Organizational Learning - Cont. Improvement (68)
Management Support for Patient Safety (65)
Overall Perceptions of Safety (56)
Communication Openness (60)
Teamwork Across Units (50)
Nonpunitive Response to Error (38)
Behavioral Health (99) 25 54 62 70 77 71 76 60 51 49 38Rehab (53) 20 52 58 83 78 70 69 54 72 48 54Women & Infants (19) 33 46 48 65 63 61 57 58 46 37 29Oncology (36) 31 62 52 70 59 68 45 46 57 28 34Cardiovascular (82) 49 46 57 81 63 63 50 56 56 61 44Surgery (165) 37 48 48 72 64 60 56 54 49 35 36CJ RI (70) 44 41 37 64 68 61 50 48 58 28 46Critical Care (84) 38 60 67 93 73 72 50 63 66 40 28Primary Care (34) 39 38 33 64 62 57 35 40 53 36 42Medicine (52) 42 70 62 79 71 58 62 74 64 54 55ED (7) 23 20 10 37 25 50 19 13 29 24 29
Launch of Team Training
Team Training Tool
• Session 1 – Crucial Conversations• Session 2 – Getting What You
Want: Communication Strategies That Help You Get What You Need • Session 3 – When the Going
Gets Tough: Achieving a Positive Outcome
Why Team Training?
Next Steps
Presentation Objectives
• Describe the root of conflict
• Understand how to reframe during negotiations
• Learn the Walk in the Woods Technique
Conflict in Health Care
Recipe for Conflict
?Ambiguity
Complexity
Vagueness
Competition
Hierarchy
High stress
Recipe for Conflict
CONSEQUENCES
Mistrust Disruptive Behavior
Changes in Policy
Is All Conflict Bad?
Power and Negotiation
Positional Bargaining
Interest-Based Negotiation
Positional Bargaining
Walk in the Woods
A Path to Interest-Based Negotiation
Geneva, Switzerland 1982
Step by Step Approach
Problem
Self-Interests
Enlarged Interests
Enlightened Interests
Aligned Interests
Solution
Stakeholders
Self-Interests (Phase 1)Problem
What Gains can come from this meeting?
Building Confidence(Trust)
Active Listening
Constructive and safe zone expression of interests
Self-Interests
Productive ConversationRecognition of the complexity of the Problem
Enlarged Interests (Phase 2)
Agreements Disagreements
1) Hire new staff 1) Reduce benefits
2) Measure quality
2)
REFRAMING
Self
Enlarged
Shared Mental Model
Enlarged Interests
Enlarged Interests
How can we REFRAME to avoid this scenario?
Enlarged Interests
What is it we agree upon?Identify and interpret each choice
Encourage questions to generate discussion
REFRAMING
Learning StepsSelf Interests Enlarged Interests
Investment
Physical
Emotional
Spiritual
Financial
Unlearning
New Learning
Enlightened Interests (Phase 3)
Imagine if….?
Enlightened Interests
Enlightened Interests
No Commitment Zone
Encourage open thinking and discussion
HumorCreativityExploration of ideas
Spurring momentum
Enlightened Interests
Ranking of ideas
Examine the enlightened list
What is agreed upon?
Is it feasible?
Ease of implementation?
6
Ease of Implementation
Feas
ibili
ty 3
2
1
Enlightened Interests
The Capacity to Imagine
Deal Makers Deal Breakers
IDEAS IDEAS
Further Negotiation3 1
2
Aligned Interests (Phase 4)
Redefining Success
I We
Overlapping Interests
Mesh
Alignment
Aligned Interests
Creating Value for All Parties
…..When YOU Succeed, then WE Succeed
When I Succeed, then YOU Succeed…..
Each party achieves a recognizable gain
Aligned Interests
Fair Equitable
Meets the Test of Time
Collaborative
Aligned Interests
Record and Sign the Agreement
Celebrate the Agreement
Action Steps
Enlightened Interests Aligned Interests
Negotiation from a Uni-dimensional approach
Action Steps
To a multi-dimensional approach
Dimensions and Service Line Comparison2009:
2013:
Service Line (responses)/Dimension (AHRQ Benchmark)
Hospital Handoffs and Transitions (40)
Staffing (53)
Feedback and Communication About Error (62)
Teamwork WITHIN units (78)
Manager Expectations & Actions Promoting Safety (72)
Organizational Learning - Cont. Improvement (71)
Management Support for Patient Safety (68)
Overall Perceptions of Safety (61)
Communication Openness (59)
Teamwork Across Units (53)
Nonpunitive Response to Error (39)
Behavioral Health (84) 47 55 62 77 81 70 64 66 63 55 54Rehab (86) 28 50 46 69 71 63 72 66 52 59 51Women & Infants (156) 47 76 64 92 84 80 77 75 68 56 49Oncology (92) 35 48 51 79 66 72 60 58 61 49 47Cardiovascular (161) 45 54 73 84 87 81 70 70 68 59 42Surgery (444) 36 58 56 75 72 73 69 68 61 50 40CJ RI (72) 51 67 67 77 78 84 81 81 57 50 39Critical Care (148) 46 49 62 86 74 76 58 62 61 56 38Primary Care (106) 32 47 43 76 70 54 66 63 58 52 36Medicine (166) 33 39 50 69 59 59 54 48 47 46 35ED (94) 29 23 48 69 65 58 46 34 42 35 20
Below the benchmark (below 90%)Caution (>90% and <95%)
Service Line (responses)/Dimension (AHRQ Benchmark)
Hospital Handoffs and Transitions (38)
Staffing (49)
Feedback and Communication About Error (60)
Teamwork WITHIN units (77)
Manager Expectations & Actions P romoting Safety (72)
Organizational Learning - Cont. Improvement (68)
Management Support for Patient Safety (65)
Overall Perceptions of Safety (56)
Communication Openness (60)
Teamwork Across Units (50)
Nonpunitive Response to Error (38)
Behavioral Health (99) 25 54 62 70 77 71 76 60 51 49 38Rehab (53) 20 52 58 83 78 70 69 54 72 48 54Women & Infants (19) 33 46 48 65 63 61 57 58 46 37 29Oncology (36) 31 62 52 70 59 68 45 46 57 28 34Cardiovascular (82) 49 46 57 81 63 63 50 56 56 61 44Surgery (165) 37 48 48 72 64 60 56 54 49 35 36CJ R I (70) 44 41 37 64 68 61 50 48 58 28 46Critical Care (84) 38 60 67 93 73 72 50 63 66 40 28Primary Care (34) 39 38 33 64 62 57 35 40 53 36 42Medicine (52) 42 70 62 79 71 58 62 74 64 54 55ED (7) 23 20 10 37 25 50 19 13 29 24 29
Summary
Conflict occurs everyday in everyway
Self Interests = Presenting each party’s interestsEnlarged Interests = Reframing occurs Enlightened Interests = Exploring the optionsAligned Interests = Agreeing on recognizable gains
The Walk in the Woods technique is a valuable strategy to use when negotiating conflict
