1. Managing Conflict Aaron Friedman MD, Hasbro Children’s Hospital Susan Bostwick MD Weill-Cornell Medical College David Keller MD UMass Medical School

2. Conflict is… The interaction of interdependent people who perceive incompatible goals and interference from each other in achieving those goals. -Hoeker & Wilmot

3. Take Home Messages Conflict is:  Inevitable (among humans)  Necessary (especially for change)  Useful (for growth and development) Today’s Goals  Assess your own approach to conflict  Understand other approaches to conflict management  Tools to consider using in conflict situations

4. Examples of Conflict Conflict in the practice:  Should we admit to the hospitalists? Something just isn’t fair:  What about our salaries? Technology driven conflict:  Upgrading to electronic medical records Generational conflict:  Housestaff clash with primary care providers Others

5. What is Conflict? Conflict is not… A sign of a bad relationship A negative experience A mistake A struggle between right and wrong Conflict is… Perceived difference in needs, values and goals Part of relationship A consequence of growth and change

6. Conflict Continuum War Undeclared war Legal Battles Hostility “Personality” Clash Disagreement ———————————————————————————— Low Intensity High Intensity

7. Advantages of Conflict Diffuse more serious conflicts Stimulate search for new facts or solutions Enhance relationships Increase cohesiveness Conflict should be managed not eliminated

8. Disavantages of Conflict Time consuming Disrupts progress/ problem solving Detracts from job at hand Keeps people apart; if unresolved Poor quality, lowers productivity Reduces team effectiveness

9. Types of Conflict IntrapersonalInterpersonal IntragroupIntergroup

10. Sources of Conflict Fear Dishonesty Boundaries Negligence Need to be right Miscommunication Mishandling conflict in the past Hidden agenda Revenge Fighting the “last war”

11. Small Group Work Take 5 minutes to read the “case study” aloud at your table and discuss the nature of the conflict presented REPORT OUT: What is the nature of the conflict?

12. Conflict Management The use of strategies and tactics to move parties toward resolution or at least containment of a dispute that avoids further escalation and relationship destruction. -Aschenbrenner

13. Conflict Management 1 Identify critical information  Whose problem is this?  What is the situation?  Issues, history, players, stake holders

14. Conflict Management 2 What organizational factors are present?  Policy/procedure, culture, working conditions  What personal factors do I need to acknowledge?  Personal issues, conflict resolution style, what pushes my buttons

15. Conflict Management 3 Personal inventory  What role does my behavior play in the dynamic?  What situational elements am I willing/able to change?  What are my resource constraints?  What matters to me -- winning? The relationship?, specific outcome?

16. Conflict Management 4 Increase my effectiveness  Acknowledge my own feelings!!  If not purely interpersonal –separate the problem and the people  Focus on interests – not positions  Generate solution option s  Consider measurable outcomes  Recognize successful conflict management

17. Conflict Management Tailor your conflict management strategies to match situations with peers, supervisors or those that report to you.

18. Conflict Management: Peers Shared interest/goals Non competitive approaches Solve this without involving others Set the ground rules early Consider humor Cultivate relationships at all times, not just during conflict

19. Conflict Management: Superiors Present relevant data accurately/concisely Be explicit about what you want Be explicit about yourself Link your goal to their values/goals Acknowledge the constraints in their positions Understand organizational culture Don’t expect gratitude or approval Don’t cause them to lose face

20. Conflict Management: Subordinates Match actions and words Assume they know more about you than you think Be explicit about expectations and consequences Give and accept feedback in private Deal fairly and objectively with poor performance Listen, learn [boomerang questions] Be a coach not a player

21. Small Group Work Back to your case. In 15 minutes, discuss:  Whose problem is this?  What is the power dynamic?  Who are the stake holders?  What organizational factors are present? REPORT OUT: Give us the bullets in 1 minute.

22. Styles of Conflict Successful leaders know their own preferred style of handling conflict, but vary their style to meet the needs of the situation..

23. Styles of conflict

24. Avoidance “You don’t have a dog in this fight” Cool down needed No chance for success Turn the other cheek  Disadvantages  Missed opportunity to clarify issue  Increases power differential  Coward/pushover label  Overused in healthcare

25. Competition True zero sum game Time constraints “Opponent's” only style  Disadvantages  Sets power wins pattern  Increases power differential  Not helpful in personal relationships  No ownership in the solution

26. Accomodation Issue more important to the other party Graceful exit strategy Value the relationship Competition getting no where  Disadvantages  You are a fixer/enabler  Doormat  Increase power differential

27. Compromise Issue and relationship important Need temporary or expedient “fix” Collaboration falters  Disadvantages  Focus on position/solution not issues  Lose-lose rather than win-win  May miss a systems solution

28. Collaboration Need to build support for implementation Addressing complex problems Change needed for the solution Allows focus on goals, issues, values not positions or demands  Disadvantages  Time consuming  Both parties need to listen and learn  Willingness to change  Needs planning and team building

29. Communication Skills LISTEN, LISTEN, LISTEN Respect Cultivate trust Stay clear, concise, positive Recognize body language Use “I” statements not “you” statements (avoid blame) Articulate your needs Acknowledge others’ needs LISTEN, LISTEN, LISTEN

30. Small Group Work Back to your case. In 15 minutes, discuss:  Discuss the pros and cons of each approach to your conflict. REPORT OUT: Give us the bullets in 1 minute.

31. Styles of Conflict To proactively manage conflict, choose the collaborative approach whenever possible.

32. Successful Conflict Management Reconsider your definitions of conflict Know your preferred style Vary your style based on situation Tailor your approach based on involved parties Proactively manage conflict – anticipate Communication – LISTEN