1. Maintaining Calm In The Sea Of Change Martha Griffis, RN, BSN, OCN Rita Suiter, Customer Service Coach South Georgia Medical Center

2. Learning Objectives Discuss change within our healthcare environment Learn about “good” and “bad” stress Learn how stress affects the body Learn ways to decrease stress Discuss conflict – a major source of stress Discuss ways to resolve conflict in a productive manner

3. Examples Of Things That “Stress Us Out” ENVIRONMENT EMR New equipment Construction Policy changes/JCAHO Traffic/Parking Healthcare climate –Cutbacks –Reimbursement issues RELATIONSHIPS Children/Family issues Coworkers Patients Doctor relationships “Walk-ins”- (unexpected customers) Schedule changes Conflict

4. USA Is A Stressful Nation! 93% of worksite accidents are the result of human error (National Safety Council) 47% of US executives surveyed in 2003 didn’t use their vacation time due to job pressures Up to 60% of all absences are caused by stress 72% of US workers report emotional stress is pervasive in the workplace More heart attacks occur on Monday mornings than any other day of the week ©2006 Wellness Councils of America

5. How Would You Define Stress? A loss of emotional control The inability to cope with problems Wear and tear on the body The absence of inner peace Changes that alter our routine – stress and change are often used to describe the same situation

6. Good Stress – Eustress Joy Happiness Euphoria Falling in love Two Kinds Of Stress

7. Bad Stress – Distress Anger Fear Impatience Frustration Rage Embarrassment Two Kinds Of Stress

8. Two Kinds Of “Distress” Acute Distress – Lasts About 20 Minutes –Speeding ticket –Run your boat into an iceberg

9. Two Kinds Of “Distress” Chronic Distress – Not nearly as intense but lasts for days, weeks, months –Job –Financial –Marriage –Chronic pain

10. -- Denis Whatley “The Chinese symbol for conflict or change is the yin/yang. It means opportunity riding a dangerous wind.”

11. The Personal Definition Of Stress The “perceived” threat (real or imagined) to one’s mind, body, spirit, or emotional state What Are YOUR Stressors? “I’m an old man now, and I have known a great many problems in my life… most of which never happened.” — Mark Twain

12. The Fight Or Flight Response This is the survival dynamic for physical stressors…or physical response to danger Everyone has the fight or flight response Women also have what is known as the “tend and befriend” response, a more nurturing response to stress

13. The Fight or Flight Response Today, the fight or flight response is used primarily (and inappropriately) for non-physical stressors, and herein lies the problem: a stress-hormone cocktail that wrecks havoc on the body under repeated bouts of chronic stress ©2006 Wellness Councils of America

14. Short Term Effects Of Stress Physiology Stress hormones released during the fight or flight response: Epinephrine Nor-epinepherine Vasopressin Aldosterone Cortisol

15. This Stress Cocktail Causes Increased: Heart rate Blood pressure Breathing pattern Muscle tension Perspiration Metabolic activity

16. Long-term Effects Of Stress Hypertension Chronic pain Muscle tension Depressed immune system Increase in colds and flu Fatigue Insomnia Depression

17. Stress and Disease 80% of visits to primary care physicians are related to stress The relationship between stress and disease is no longer thought to be associated, but a direct link “Ultimately the body becomes the battlefield for the war games of the mind.” —Brian Luke Seaward, Ph.D.

18. Fear And Anger Fear is the flight response Anger is the fight response Left unresolved, fear and anger become control issues

19. Fear And Anger Left unresolved, these emotions may result in chronic health issues: Lupus TMJ Headaches Fibromyalgia

20. What Do Frasier’s Dad And Change Have In Common? Change is NOT comfortable! Staff satisfaction is disrupted Frustration builds during adaptation Positive attitudes are contagious while negative attitudes are infectious

21. Culture Change Involves Knowledge! Knowledge management will not be effectively implemented without a culture of collaboration, trust, and mutual respect among the staff Avoid being: “out for the individual” – look for the good of the team Controlling about your job knowledge – share what you know and we all win!

22. Fear and Anger Can Lead To Conflict

23. Thought For The Day Customers may come and go Co-workers stay longer!

24. What Is Conflict? Conflict occurs when there is a difference of opinion Conflict is natural Conflict does not have to be personal Conflict can be constructive OR destructive

25. Workplace Conflicts Are…  About understanding differences  An opportunity to build positive relations

26. Distinguishing Between Two Types of Conflict The issue The way conflicts are being managed

27. Three Different Approaches: Aggressive – direct/controlling –Escalates conflict Passive – indirect/submissive –Passes the buck/finger pointing Assertive – direct / working together –Resolves Conflict

28. Four Conflict Traps: Fighting for the last word Saying things are resolved when they are not Dismissing the issue completely Serving up “put-downs”

29. Trap One: Fighting For The Last Word Allow your coworker to have the last word Count more than 10 before you respond Use empathetic phrases Be assertive, not aggressive

30. How To Assert Yourself Be specific Stick to the facts Never say never or always Make sure your face reflects the message you want to convey Make eye contact Don’t fidget

31. Trap Two: Saying Things Are Alright If you are a smoother: Never assume things will get better on their own Tell someone Be proud of your courage

32. Trap Two: Saying Things Are Alright If you are a smoothie: Ask general questions…dig deeper Ask specific questions Don’t overreact

33. Trap Three: Dismissing The Issue 4 steps in dealing with a coworker who has withdrawn from the situation: Resist the urge to push Use an empathetic tone of voice Seek out the coworker’s advice Establish a specific mutually agreed upon time

34. Trap Four: Serving Up Put-downs Don’t get defensive…stay in control Be interested…listen to the hidden message Get to the root of the cause…ask what you did to upset them

35. Competitive Climate Mistrust Suspicion Self-interests Lack of team spirit

36. Basic Human Nature: “In any controversy, the instant we feel anger, we have already ceased striving for truth, and have begun striving for ourselves. Men are not AGAINST you…they are merely for themselves.” --Unknown

37. Competitive Results Flow of information and resources halted Unproductive conflict Productivity is deterred Increases stress Decreased morale Harsh confrontations

38. Conflict Is Destructive When: The problem is not resolved It drains energy from more important issues It destroys the team spirit The team or individuals become divided

39. Cooperative Climate Trust Information sharing Exchange of resources Risk and efforts supported Team spirit

40. Cooperative Results Conflicts are managed productively Higher productivity Higher quality Reduced stress Strengthened working relationships Collaboration Freedom of expression Exploration of alternatives, creativity, and confidence

41. Conflict Is Constructive When: People grow and change positively from the experience The conflict provides a win-win situation Involvement is increased for everyone affected by the conflict Team cohesiveness is increased

42. Use Your L.E.A.D. Skills L isten E mpathize A pologize D ecide

43. Planning For Conflict Resolution Choose the time and place carefully Change behavior– not people Agree on something Use “I” language Figure out your part in the conflict

44. Planning For Conflict Resolution Criticize concretely – be specific! If emotions run high – bow out for a while Find the win-win solution

45. When You Are the Most Anxious..Remember the Three C’s Remain Confident Calm In Control

46. Action Guides For Conflict Management Discuss cost of destructive conflict Avoid blaming Demonstrate understanding Change your behavior Prepare alternatives Take the first steps Check your assumptions Deal with negative attitudes Remain open-minded Focus on working together

47. Pitfalls To Avoid: DON’T ASSUME: Discussing conflict will escalate the problem You alone must change Your opponent alone must change

48. Pitfalls To Avoid: DON’T: Believe that your challenger WANTS to be frustrating and difficult Wait for the other to make the first move

49. Make Sure That You Do: Keep arguments rational and task oriented Believe that conflict can be resolved with positive results!

50. Conflict Summary: Put problem people in proper perspective Take your pick: positive or negative Don't expect difficult people to change Learn to respond as well as listen Give and request frequent feedback

51. "There are two primary choices in life: to accept conditions as they exist, or accept the responsibility for changing them." --Denis Waitley

52. Reduce Conflict And Stress Recognize the signs of stress –Physical, mental, emotional Keep a positive but realistic attitude Develop time management skills Learn to communicate well Take good care of yourself Reduce alcohol intake instead of escalating

53. Reduce Conflict And Stress Become more spiritual –Be in tune with yourself –Take time out for me –Seek to read articles and books that “feed your soul” –Make less lists and pay more attention to the life we have “in the moment”

54. Become Fully Engaged In Living “…we need to wonder how we lost touch with ourselves and with the fundamental breathing rhythm of the cosmos. How have we forgotten the rhythms of day and night, new and full moon, spring and fall, in breath and out breath? How might we regain our living, pulsing, embodied place within the greatness of nature?” Jacob Needleman

55. Stress Reduction Exercises: Regular exercise reduces stress Deep breathing exercises Yoga Tai-Chi Guided imagery

57. “I cannot and should not be cured of my stress, but merely taught to enjoy it.” —Hans Selye ©2006 Wellness Councils of America