1. Dealing with Conflict in Health Care: The Next Dimension of Team Training Scott Ellner, DO, MPH, FACS Vice Chairman of Surgery Saint Francis Hospital and Medical Center Hartford, Connecticut JUNE 27, 2013

2. Blame and Shame

3. Identify Culture Communication Behavior Rituals Tolerance

4. OR Safety Attitudes Questionnaire - SAQ 12. In the OR, it is difficult to discuss errors. 12345

5. SAQ Participants N=165

6. Dimensions and Service Line Comparison 2009:

7. Launch of Team Training

8. 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

9. Why Team Training?

10. Next Steps

11. Presentation Objectives Describe the root of conflict Understand how to reframe during negotiations Learn the Walk in the Woods Technique

12. Conflict in Health Care

13. Recipe for Conflict ? Ambiguity Complexity Vagueness Competition Hierarchy High stress

14. Recipe for Conflict CO NS EQ UE NC ES Mistrust Disruptive Behavior Changes in Policy

15. Is All Conflict Bad?

16. Power and Negotiation

17. Positional Bargaining

18. Interest-Based Negotiation

19. Positional Bargaining

20. Walk in the Woods A Path to Interest-Based Negotiation

21. Geneva, Switzerland 1982

22. Step by Step Approach Problem Self-Interests Enlarged Interests Enlightened Interests Aligned Interests Solution

23. Stakeholders

24. Self-Interests (Phase 1) Problem What Gains can come from this meeting? Building Confidence (Trust) Active Listening Constructive and safe zone expression of interests

25. Self-Interests Productive Conversation Recognition of the complexity of the Problem

26. Enlarged Interests (Phase 2) AgreementsDisagreements 1) Hire new staff1) Reduce benefits 2) Measure quality 2) REFRAMING Self Enlarged Shared Mental Model

27. Enlarged Interests

28. How can we REFRAME to avoid this scenario?

29. Enlarged Interests What is it we agree upon?Identify and interpret each choice Encourage questions to generate discussion REFRAMING

30. Learning Steps Self Interests Enlarged Interests Investment Physical Emotion al Spiritual Financial Unlearning New Learning

31. Enlightened Interests (Phase 3) Imagine if….?

32. Enlightened Interests

33. No Commitment Zone Encourage open thinking and discussion Humor Creativity Exploration of ideas Spurring momentum

34. Enlightened Interests Ranking of ideas Examine the enlightened list What is agreed upon? Is it feasible? Ease of implementation? 6 Ease of Implementation Feasibility 3 2 1

35. Enlightened Interests The Capacity to Imagine Deal Makers Deal Breakers IDEAS Further Negotiation 3 1 2

36. Aligned Interests (Phase 4) Redefining Success I We Overlapping Interests Mesh Alignment

37. 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

38. Aligned Interests FairEquitable Meets the Test of Time Collaborative

39. Aligned Interests Record and Sign the Agreement Celebrate the Agreement

40. Action Steps Enlightened Interests Aligned Interests Negotiation from a Uni-dimensional approach

41. Action Steps To a multi-dimensional approach

42. Dimensions and Service Line Comparison 2009: 2013:

44. Conflict occurs everyday in everyway Self Interests = Presenting each party’s interests Enlarged Interests = Reframing occurs Enlightened Interests = Exploring the options Aligned Interests = Agreeing on recognizable gains The Walk in the Woods technique is a valuable strategy to use when negotiating conflict

45. Thank You Scott Ellner, DO, MPH, FACS sce107@mail.harvard.edu