Conflict Management In Health Care

Transcription

1 Conflict Management In Health Care Pat F. Bass III, M.D., M.S. Gregg M. Talente, M.D., M.S. Jo Ann Wood, M.D., M.S. Conflict: A Definition Conflict is an expressed struggle between at least two interdependent parties who perceive incompatible goals, means, values, and/or beliefs. Parties to a conflict must perceive they are in conflict. Perceptions, emotions and behavior form an interactive system. Definition of Conflict Management Conflict management is the use of strategies and tactics to move all parties toward resolution, or at least containment of dispute, in a manner that avoids escalation and the destruction or relationships. Carol A. Aschenbrener, MD 1

2 Antecedent Conditions - Competition for resources - Task interdependence - Jurisdictional (role) ambiguity - Status struggles - Out-of-role actions - Communication barriers - Values, beliefs, biases and expectations - Habits and habitual practices - Frames of reference/past experience Types of Conflict (1) Substantive conflict (intrinsic conflict) Task related conflict Procedural conflict (goal-path conflict) (2) Affective conflict (extrinsic conflict) Interpersonal conflict Power related conflict How Do I Approach Conflict? Thomas-Kilmann Conflict Mode Instrument Kenneth W. Thomas and Ralph H. Kilmann 2

3 Two Basic Dimensions of Conflict Behavior Concern about your own outcomes Concern about the other party s outcomes Competing or Dominating The goal is to win Use of power and influence to achieve your goals My way Collaborating or Integrating The goal is to find a win/win solution An open problem-solving approach to meet everyone s interests to greatest extent possible Our way Compromising The goal is to find a middle ground A pragmatic approach of trading concessions to make a deal Half way Avoiding or Inaction The goal is to do nothing or delay Denial of the existence of conflict or unwillingness to deal with the issues No way Accommodating or Obliging The goal is to let the other party win Giving the other side what they ask or demand Your way Competing or Dominating Your are negotiating with a competing or dominating style if you: 1. Persist until you get what you want. 2. Use your power to influence the outcome of a negotiation. 3. Try to outsmart and outtalk the other party. 4. Withhold information that might give the other party an advantage. 5. Exploit the other parties weaknesses in a negotiation. 6. Trying to convince the other party. 3

4 Competing or Dominating Situations Where Appropriate: 1. Issue is trivial or important to you. 2. Speedy decision is needed or only short term goals are present. 3. Unpopular course of action is implemented. 4. Necessary to overcome assertive subordinates. Situations Where Inappropriate: 1. Issue is complex. 2. Issue is not important to you. 3. Both parties are equally powerful. 4. Decision does not have to be made quickly. Source: Rahim Organizational Conflict Inventories: Professional Manual, Competing/Dominating Benefits: Asserting your position Possibility of a quick victory Self-defense Testing assumptions Disadvantages: Sets a pattern about use of power May increase power differential, harm relationships Doesn t build ownership, may create resistance Possible escalation and deadlocks Collaborating or Integrating You are negotiating with a collaborating style if you: 1. Bring issues into the open. 2. Issues are important to both parties. 3. Looking for creative solutions. 4. Seek to build trust and satisfy both parties. 5. Exchange information and ideas freely 4

5 Collaborating or Integrating Situations Where Appropriate: 1. Issues are complex and multiple resources needed. 2. Synthesis of ideas is needed to come up with better solutions. 3. Commitment is needed from other parties for success 4. Time is available for problem-solving and no one group solution. Situations Where Inappropriate: 1. Task or problem is simple. 2. Immediate decision is required. 3. Other parties are unconcerned about outcome. 4. Other parties do not have problem-solving skills. Collaborating/Integrating Benefits : High quality decisions Learning and communication Resolution and commitment Strengthening relationships Disadvantages: Time and energy required Parties must be willing to listen and learn Requires reflection Vulnerability risk Compromising You may be using this style if you are: 1. Splitting the difference. 2. Giving up something for something in return. 3. Taking an intermediate position 4. Engaging in give and take 5

6 Compromising Situations Where Appropriate: 1. Goals of parties are mutually exclusive. 2. Parties are equally powerful. 3. Consensus cannot be reached. 4. Integrating or dominating style is not successful. 5. Temporary solution to a complex problem is needed. Situations Where Inappropriate: 1. One party is more powerful. 2. Problem is complex enough to need a problem-solving approach. Source: Rahim Organizational Conflict Inventories: Professional Manual, Compromising Benefits: Pragmatism Speed and expediency Fairness Maintaining relationships Disadvantages: Focus may shift to positions and not core issues Very difficult to balance so that all parties feel they have fared equally Superficial understandings, may not learn what is important to continuing relationship Avoiding or Inaction You may be using this style if you: 1. Avoid situations that create tension 2. Avoid controversy 3. Avoid open discussions of issues or concerns 4. Postpone difficult negotiations 6

7 Avoiding or Inaction Situations Where Appropriate: 1. Issue is trivial. 2. Potential dysfunctional effect of confronting the other party outweighs benefits of resolution. 3. Cooling off period is needed. Situations Where Inappropriate: 1. Issue is important to you. 2. It is your responsibility to make the decision. 3. Parties are unwilling to defer; issue must be resolved 4. Prompt attention is needed. Source: Rahim Organizational Conflict Inventories: Professional Manual, Avoiding/Inaction Benefits: Reducing stress Saving time Steering clear of danger Setting up more favorable conditions Disadvantages: Missed opportunities to clarify issues or relationships Issues not clarified often trigger additional conflict later Others may doubt your courage May be perceived as a push over if over-used Accommodating or Obliging You may be using this style if you: 1. Focus on other parties concerns more than your own 2. Trying to help the other party even when it means giving something up 3. Trying to keep the other party happy 4. Trying not to hurt the other parties feelings 7

8 Accommodating or Obliging Situations Where Appropriate: 1. You believe that you may be wrong. 2. Issue is more important to the other party. 3. You are willing to give up something in exchange for something from the other party in the future 4. You are dealing from a position of weakness. 5. Preserving relationship is important. Situations Where Inappropriate: 1. You believe that you are right. 2. Issue is important to you. 3. The other party is wrong or unethical. Source: Rahim Organizational Conflict Inventories: Professional Manual, Accommodating/Obliging Benefits: Helping someone out Restoring harmony Building relationships Choosing a quick ending Disadvantages: Overuse may foster dependency You may become an enabler Overuse may create the perception that you will go along or can be ignored Preparation- 3 Questions 1. What do I want? 2. Why should they negotiate with me? 3. What is my best alternative to a negotiated agreement (BATNA)? 8

9 What Do You Want/ What Do They Want? 1. Focus on commonalities, rather than differences. 2. Address needs and interests, not positions. Emphasize Commonalities, Minimize Differences Define your individual goals. Understand what it is that you hope to achieve. Work to understand the goals of the other negotiating parties. Recognize that there will be differences in priorities and preferences. Define both sets of goals as best achievable through collaboration. What do your goals have in common? How might the achievement of each party s individual goals support the achievement of a collective goal? Address Interests, not Positions POSITIONS INTERESTS Things you say you want Demands Things you say you will do Things you say you won t do Underlying motivations Needs and concerns Hopes and fears 9

10 Address Interests, not Positions How do you discover your interests? Ask yourself: What do I really want from the negotiation? What do I really want from the process? What do I really want from the relationship? What do I really need from all three? How would I feel if I got what I m asking for? Focus on Interests, not Positions How do you discover their interests? Next, consider their interests. Be curious, not suspicious. Ask Why? or Why not? Ask For what purpose? Ask for a critique of your proposal. Use the scaled numbers technique. Why Should they Negotiate With You People will not negotiate with you unless they believe you can help them or hurt them How might you help/ hurt the other party: Financially Psychologically Materially Physically 10

11 BATNA Yours Theirs 11