1. Conflict A Process-Based Approach for Organizational Leaders 1,2 A Presentation for Nurse Leaders Kendall L. Stewart, MD, MBA, DFAPA February 25, 2008 1 I intend to describe a practical process you can begin following today. 2 Please let me know whether I have succeeded on your evaluation forms.

2. Why is this important? Conflict—in every part of our lives—is inevitable. It can be good or bad. We’d all like to minimize destructive conflict and maximize constructive conflict. But that’s hard. Most of us avoid conflict when we can. And we handle it poorly the rest of the time. 1,2 This presentation will offer a practical process to follow that can produce better results. After mastering the material in this presentation, you will be able to –Identify three factors that promote constructive conflict, –Describe three causes of destructive conflict in the workplace, –Point out three mistakes that leaders often make when attempting to manage conflict, and –Detail three key steps in a practical process for managing conflict effectively. 1 Dr. Jitendra Patel recently described one way to manage conflict. 2 A woman approached a pharmacist and asked for cyanide.

3. When is conflict constructive? When it stimulates creativity and innovation When it encourages critical thinking and careful care preparation When it discourages “group think” 1,2 When it builds commitment for the ultimate decision When its resolution builds real relationships 1 The conventional wisdom is often wrong. 2 A nurse aide offered the real answer for why our patients were dissatisfied with the food.

4. What promotes constructive conflict? More facts Less opinion Humor Respect Multiple alternatives Less ego A mutual desire to find the best option A diminished power differential Adherence to a dispassionate problem- solving process A focus on position instead of person A desire for constructive conflict 1,2 1 Imagine for a moment that you an SOMC executive attempting to forecast the number of ED visits in FY 09. 2 Why will the number of visits increase? Why will they decrease?

5. What are some causes of destructive conflict in the workplace? Miserable people Lack of clear goals Weak leaders Autocratic leaders 1,2 Lack of data Pushy people Insistence on consensus Strong feelings Sensitive people Conflict avoidance Moody leaders Lazy people Unchallenged negativism Selfish people Gossip on life support Discouragement of disagreement Impulsive decision making Limited alternatives Perceived favoritism Lack of participation in decision making Unpredictability 1 A fellow medical student went to see a professor to ask why the answers to the same questions had changed. 2 We hissed a professor who gave one A, two Bs and the rest Cs to our medical school class.

6. Why do we tend to avoid conflict? Because it makes us uncomfortable Because we don’t know what to do Because we don’t have much experience Because our role models handle it badly Because no one will help us Because it’s the course of least resistance Because we can get away with it Because it’s what everybody else does Because there are so many other less important things to do. And, sometimes, because it’s the best option. 1,2 1 I decided to see whether my wife and I could actually put off an argument. 2 When we pulled into the parking space at the steakhouse, I asked whether we could table this until after dinner.

7. What is a typical conflict scenario? A nurse manager concludes that she must revise the schedule to decrease overall overtime and to achieve a sense of fairness on the unit. Two long-term employees were hired years ago with the promise that they would not have to work on the weekends. These employees have resisted any changes in their schedules using that history as their defense. Meanwhile, resentment has grown along with overtime. After informing the employees of her intent, the manager posts the new schedule. All heck breaks loose. The employees threaten to quit. They solicit support from their colleagues who resent being put in the middle.

8. What mistakes do leaders often make when dealing with conflict? Avoiding it altogether Trying to keep the peace at any price Not holding troublemakers and slackers accountable Not holding high performers accountable Not holding anyone accountable Taking one side before hearing both Holding secret meetings with individuals Showing favoritism Putting people in the middle Permitting dissidents to exercise veto power Making unilateral changes without consulting or informing those affected Procrastinating Making partial decisions over an extended period of time Making decisions when angry or frustrated Accepting “the monkey” from disgruntled workers Arguing instead of listening Failing to accept feelings Using someone else as the “hammer” 1 I always urge my patients to never say, “Well, Dr. Stewart says...” 2 If you agree with the position say, “My position is...”

9. What process—if followed—will produce the best results? Expect it. Remind yourself that you always have options and that you always have a best option. Remember that doing nothing may be the best option. Monitor your arousal and strive to remain dispassionate. Listen carefully—to both sides. Never agree to confidentiality beforehand. Document complainers’ positions and hold them accountable for their behavior and their positions. React quickly when it is appropriate. Beware requests to vent. Do not participate in ambushes. 1,2 Accept perceptions for what they are. Insist on data. Focus on behavior instead of motive. Attach unpleasant consequences to bad behavior. Look for a way for everyone to save face. Explore possible consequences from the start. Focus on the common ground. Start with the easy stuff. Put off the hard stuff. Get some agreement to build momentum. Agree to disagree agreeably. Set realistic expectations. Extrude net-negative people. Trade up at every opportunity. 1 Psychiatrists try all kinds of crazy stuff. 2 Two women wanted to “confess” their infidelities in my presence. That’s why people watch The Jerry Springer Show.

10. What have we learned? Conflict is inevitable. It can be a very good thing. It can be very destructive. Conflict will not manage itself. Leaders will be most successful in dealing with conflict if they follow a process that works. That will not be easy, but it can be done. And the results will be worth the effort. 1,2 1 Sometimes, confrontation is the only way to right the little wrongs of everyday life. 2 I confronted the greedy missionary and the manipulative evangelist.

11. Where can you learn more? 1 Stewart, Kendall L., et. al. A Portable Mentor for Organizational Leaders, SOMCPress, 2003 1 Please visit www.KendallLStewartMD.com to download related White Papers and presentations.

12. How can you contact me? 1 Kendall L. Stewart, M.D. VPMA and Chief Medical Officer Southern Ohio Medical Center President & CEO The SOMC Medical Care Foundation, Inc. 1805 27th Street Waller Building Suite B01 Portsmouth, Ohio 45662 740.356.8153 StewartK@somc.org KendallLStewartMD@yahoo.com www.somc.org www.KendallLStewartMD.com 1 All speaking and consultation fees are contributed to the SOMC Endowment Fund.

13.   Safety Safety  Quality Quality  Service Service  Relationships Relationships Performance  Are there other questions? www.somc.org