Finding Middle Ground Team Conflict and Process Alzheimer Society of Manitoba Conference March 5, 2007 Peter S. Silin, MSW, RSW Diamond Geriatrics, Inc. ©

Lawsuits, Threats, Explosions and Amazing Things

The Process Three parts to work with challenging families  Level I: Effective initial assessments  Level II: Effective problem understanding  Level III: Effective responding  One on One  Meetings  The better and earlier prepared, the easier it will be.  Prevention

Assessments

Good Ax = Problem understanding  “ Difficult Families:” Care Home Study  Good assessments give  Problem understanding  Predictability  Prevention: Where to put time and attention  Directions for problem solving

Initial Assessments: Resident  General  Social Histories and Psychosocial  C.A.V.E. Model : Care According to Values Expressed

C.A.V.E ©  Focuses primarily on “personhood” of the client or service receiver.  Focuses on the spirit, personality, what makes this person who they are and unique.  Requires the person or people providing services to focus on the person as a person, not as a “set of needs.”  Not a needs based system.  Does not deny that an individual has needs, nor that a needs based model can be used concurrently.

C.A.V.E ©  Provision of service follows from understanding who someone is  Asks: what is/has been important to you? How have you lived/do you want to live your life  What are the values that you have lived under, and currently operate from?  What are some of the hard decisions you have made?  It says to individual, families, caregivers, we want to help live life the way you want to live it.

C.A.V.E ©  Resident generated vs. resident centred  An “inside out” model  Establishes a value base of care

Initial Assessments: Family  History  Dynamics: The Family Dance  Then they’ll assume you cha-cha  Relationships  Between Caregiver and resident  Between Family Caregivers

Initial Assessments: Families II  Individual Family Members  Emotional  Personality  Life Stressors  Previous History—Individual  Personal Agendas  Supports  Care Maps

Assessing Us: Assessing Validity  Flexibility  Self  staff  Administrator  system board  Rigid Systems  The meaning of no  Then everyone will want to do it

Assessing Us: Assessing Validity II  Egos taking precedence to care  Personal histories and triggers  The meaning of conflict  INAM: it’s not about me  Emotional Intelligence :  Understand one’s own and others emotions, express them; ability to understand and manage relationships and emotional process in relationships. Leads to ability to handle oneself and relationships.

Understanding and Assessing the Concern

The Problem: About the Concern Levels of Difficulty/ Influence 1  Facility:  Staff Action  The System  External systems  We can influence

The Problem: About the Concern Levels of Difficulty/ Influence 2  Relationship/ Emotions  Facility interaction/relationship/team process  Grief, loss, guilt, fear, etc  Family dynamics  Sometimes we can influence

The Problem: About the Concern  Levels of Difficulty/ Influence 3  Them  Past injuries and history  Personality  We cannot influence

The Response

Response Ability  Organizational Health  Climate: Fun and Humour  Staff relations and relationships  Staff validation and support  Communication, information, feedback systems  Preparations for strife  Policy and procedures for difficulties  Rounds/Education  Early identification  Response planning  Group and conflict resolution skills

When we can influence Provide What We Can Level 1  Provide information  Allow our systems to bend  Problem solving Level 2  Empathy  Supportive or intensive counselling  Work on relationship/team building  Follow-up and review

When we can influence Using Resources  Peer support and Family councils  Websites  Books and articles  System consultants  Outside Agencies and consultants

When We Don’t Have Influence Level 3  Empathic Response  Find the grain of truth  Acknowledge the mistakes  Ask where they can help us  Systemic Response  Options/Limits  Follow-up  Start early

Specific Techniques  Responding to personalities  Bullying: setting limits  Splitting: create a uniform team, support each other  Slow things down: breathing, delayed response  Mirroring  Meta comments/ Comment on process  “I” statements

Meetings: Conditions for Positive Outcome Meetings: Conditions for Positive Outcome  No hallway meetings  Set up a time and place  Decide on who should be there  Enough time and time limit  Set it Up  Why it is being held  Tentative goals

Create Conditions for Positive Outcome: Preparations  Debrief your group  Reframe your views  Decide on roles task and process  Self awareness of your triggers

Meeting Process  Meetings: Set the Stage  Define the issue  Agree on goals or objectives  Agree on process of meeting  Acknowledge the difficulties and emotions  Discuss the issue  Review history  Ask for their comment on this  Make sure they feel understood  Look for solutions  Brainstorming, best possible, win-win  Discuss and define follow-up

Post Meeting/ Planning Meeting  Debrief/How did it go  Response plan  Consistency  Team buy-in  System wide  Provide resources and education

Prevention  Review admission/assessment procedures  Review team building  Review team maintenance  Review yourself

Conflict & Quality Improvement  How do we use conflict to improve quality of care?  Data collection  Systemic change