Conflict Resolution. A Core Leadership Attribute Seminar on Negotiation
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1 Conflict Resolution A Core Leadership Attribute Seminar on Negotiation Created By: Gus M. Garmel, MD, FACEP, FAAEM Clinical Professor, Department of Surgery Co-Program Director, Stanford/Kaiser Emergency Medicine Residency Stanford University, Palo Alto, California Tenet Editor: Barbara Blok, MD, FACEP Assistant Director, Denver Health Residency in Emergency Medicine University of Colorado School of Medicine, Aurora, Colorado Negotiation Conflict Resolution 1
2 Negotiation Conflict Resolution 2
3 Negotiation Conflict Resolution 3
4 Intensity Course of Conflict Stalemate Communication Failures & Conflict Escalation Negotiation & Conflict Resolution Time Negotiation Conflict Resolution 4
5 Outline Definitions & Relevance Types & Factors of Conflict Conflict Resolution Keys & Principles Barriers The Art of Communications Process of Negotiation Negotiation Conflict Resolution 5
6 Conflict DEFINITION Any situation where incompatible activities, feelings, or intentions occur together. A competitive or opposing action of incompatibles; an antagonistic state of action (divergent ideas, interests, or persons). Mental struggle resulting from incompatible or opposing needs, drives, wishes, or external or internal demands. Negotiation Conflict Resolution 6
7 Conflict Resolution DEFINITION A range of processes aimed at alleviating, eliminating, or resolving conflict or its sources. The methods and process of negotiation, arbitration, and institution building which promote the peaceful ending of social conflict and war. Negotiation Conflict Resolution 7
8 Negotiation DEFINITION A dialogue intended to: Resolve disputes Agree upon course of action Bargain for advantages Satisfy various interests Negotiation Conflict Resolution 8
9 Relevance Model of the Clinical Practice of Emergency Medicine* COMMUNICATION AND INTERPERSONAL SKILLS ISSUES Complaint Management Conflict Resolution Interdepartmental and Medical Staff Relations Team Building Teaching *Created through collaboration of ABEM, ACEP, CORD, EMRA, RRC-EM, and SAEM Negotiation Conflict Resolution 9
10 Relevance - For Emergency Medicine Conflict is often outcomes-driven and not process-driven Physicians are typically goal-oriented EPs want to win & desire control EPs focus on immediate outcomes (want things to happen now) great for patients challenging for administrators/consultants Negotiation Conflict Resolution 10
11 Relevance - For Emergency Medicine Salaries & Schedules Positions & promotions Patient care Interpersonal interactions Medical legal protection Professional satisfaction Career security Negotiation Conflict Resolution 11
12 Relevance - Example E G An emergency RN will not perform a certain task you have requested because she doesn t feel it is necessary. You are a good clinician, but you have a reputation in your ED as being difficult. Negotiation Conflict Resolution 12
13 Relevance - Example E G 76 year old female who doesn t feel well is brought to the ED by her adult son. Her entire work-up is negative, but the son wants her admitted, despite no medical nor social indication. Negotiation Conflict Resolution 13
14 Relevance - Example E G A consultant doesn t think that he needs to see the patient you are calling about at 1 AM. You don t know this individual, but you ve heard he is not well-liked by your colleagues. Negotiation Conflict Resolution 14
15 Conflict is Inevitable Negotiation Conflict Resolution 15
16 Why Do We Conflict? Personal differences Information deficiency Role incompatibility Environmental stress Negotiation Conflict Resolution 16
17 Types of Conflict Intrapersonal Interpersonal Intragroup Intergroup Negotiation Conflict Resolution 17
18 Types of Conflict - Intrapersonal conflict Conflict within Example Conflict in dealing with a particular type of patient Negotiation Conflict Resolution 18
19 Negotiation Conflict Resolution 19
20 Types of Conflict - Intragroup conflict Conflict between individual group members Example Your colleague always grabs the sickest patients and major resuscitations Negotiation Conflict Resolution 20
21 Types of Conflict - Intergroup conflict Conflict between 2 groups of people Example Who performs the ED thoracotomy in a trauma resuscitation (EM vs. Surgery) Negotiation Conflict Resolution 21
22 Types of Conflict - Interpersonal conflict Conflict between 2 persons Example Conflict with a patient s family member or nurse Negotiation Conflict Resolution 22
23 Factors in Conflict Personal Attributes Gender Ethnicity/Culture Negotiation Conflict Resolution 23
24 Factors in Conflict - Personal Attributes Keirsey s 4 Temperaments Negotiation Conflict Resolution 25
25 Factors in Conflict - Personal Attributes Keirsey s 16 Categories ARTISAN GUARDIAN IDEALIST RATIONAL Promoter Supervisor Teacher Field marshal Crafter Inspector Counselor Mastermind Performer Provider Champion Inventor Composer Protector Healer Architect Negotiation Conflict Resolution 26
26 Factors in Conflict - Gender Negotiation Conflict Resolution 29
27 Factors in Conflict - Gender Negotiation Conflict Resolution 30
28 Factors in Conflict - Ethnicity & Culture Language Behavior nuances Negotiation style Passion Tempo Culture Custom Negotiation Conflict Resolution 31
29 Conflict Resolution How do we get there? Negotiation Conflict Resolution 32
30 Conflict Resolution - The keys & principles Gain insight Truth always Seek wisdom Never criticize Offer assistance Negotiation Conflict Resolution 33
31 Conflict Resolution - The keys & principles * Garmel GM. Conflict Resolution in EM. In Adams Emergency Medicine (Elsevier), Negotiation Conflict Resolution 34
32 Conflict Resolution - The keys & principles * Garmel GM. Conflict Resolution in EM. In Adams Emergency Medicine (Elsevier), Adapted from Ahuja J, Marshall P. Conflict in the emergency department: Retreat in order to advance. Can J Emerg Med 2003;5: Negotiation Conflict Resolution 35
33 Conflict Resolution - Barriers Preformed judgments Poor communication skills Cultural/gender barriers Lack of understanding of both sides Not possessing the right skill set Not understanding negotiable vs. nonnegotiable Pride Negotiation Conflict Resolution 37
34 Conflict Resolution - Barriers Cynicism Criticism Comparing Competing Complaining Contending Negotiation Conflict Resolution 38
35 Conflict Resolution - Pearls Plan ahead for all possible outcomes Know related policies &procedures Respect your primary responsibilities & obligations Seek to Gain consensus, not to prove a point Recognize that the truth lies somewhere in the middle Negotiation Conflict Resolution 39
36 Negotiation Conflict Resolution 40
37 Negotiation Conflict Resolution 41
38 Negotiation Conflict Resolution 44
39 The Art of Communication Effective Communication is essential for Conflict Resolution Negotiation Conflict Resolution 45
40 The Art of Communication Avoid (Obvious) Pitfalls I m the attending! Because I said so! I m right! (or, You re wrong!) My way is the only way! You re just a nurse/tech/np/internist! You re an XXXXX! Negotiation Conflict Resolution 46
41 The Art of Communication Strive to find mutual understandings I can see your point, but I don t feel you are considering mine. Let s discuss this a bit more from the patient s perspective. I ve always respected (appreciated) your It seems that we disagree, which is fine, but I m just not comfortable with Negotiation Conflict Resolution 47
42 The Art of Communication - Effective vs. Ineffective Effective Smile Eye contact Avoiding emotion Active listening Concentration Attention Focused Ineffective Snarl Arms across chest Finger pointing Pacing Distracted Inattention Disengaged Negotiation Conflict Resolution 48
43 The Art of Communication Negotiation is the art of letting them have your way. - Daniel Vare Negotiation Conflict Resolution 49
44 The Art of Communication Let us never negotiate out of fear - But let us never fear to negotiate. - President John F. Kennedy Negotiation Conflict Resolution 50
45 Process of Negotiation - The definition revisited Negotiation is a dialogue intended to: Resolve disputes Agree upon course of action Bargain for advantages Satisfy various interests Negotiation Conflict Resolution 51
46 Process of Negotiation - Objectives Mutually satisfactory structure Executed agreement Lasting and mutually beneficial relationship Comfort with process and outcome Accounts for feelings Negotiation Conflict Resolution 52
47 Process of Negotiation - Outcomes I Win Win/Win Lose/Win You Win You Lose Win/Lose Lose/Lose I Lose Negotiation Conflict Resolution 54
48 Process of Negotiation - Steps to success Have a plan Broad to narrow Actively listen & learn Take notes Unbundle issues Paraphrase don t parrot Negotiation Conflict Resolution 55
49 Process of Negotiation - Timeline Initial - assess situation, gather information (from multiple sources), establish trust, build the relationship Middle - patience, gather facts, consider counteroffers, mutual concessions End - accept, get mediator, walk away, follow-up, be gracious and complementary Negotiation Conflict Resolution 56
50 Process of Negotiation - Responses Negotiation Conflict Resolution 57
51 Process of Negotiation - Styles Negotiation Conflict Resolution 58
52 Process of Negotiation - Principled negotiation An interest-based approach to negotiation focusing primarily on conflict management and conflict resolution. Uses an integrative approach to find a mutually shared outcome Negotiation Conflict Resolution 59
53 Process of Negotiation Focus on the issues, not positions Negotiation Conflict Resolution 60
54 Process of Negotiation - BATNA? Best Alternative To a Negotiated Agreement (BATNA) What will happen if negotiations fail? Your course of action Their likely course of action Negotiation Conflict Resolution 61
55 Process of Negotiation - BATNA Develop your BATNA and attempt to determine theirs Only reveal your BATNA if it is better than theirs Consider accepting terms when their proposal is better than your BATNA Reject terms when their proposal is worse than your BATNA Negotiation Conflict Resolution 62
56 Process of Negotiation - Barriers Emotions Fear & Anger Difficult Questions Difficult Personalities Complex Situations Negotiation Conflict Resolution 63
57 Process of Negotiation - Barriers: Emotions Fear is like fire. If controlled it will help you; if uncontrolled, it will rise up and destroy you. Men's actions depend to a great extent upon fear. We do things either because we enjoy doing them or because we are afraid not to do them. - John F. Milburn Negotiation Conflict Resolution 64
58 Process of Negotiation - Barriers: Difficult Questions Defer Deflect Delay Decline Negotiation Conflict Resolution 65
59 Process of Negotiation - Barriers: Difficult Personalities Often unavoidable May result in or escalate conflict Individual may have a position of authority Strategies Don t reciprocate/stay positive Deal only with YOU Take a surprising step Negotiation Conflict Resolution 66
60 Process of Negotiation - Barriers: Complex Situations Repeat over time Multi-issue Multi-party Intangible factors Intra-organizational Tangible factors Negotiation Conflict Resolution 68
61 Process of Negotiation - Pearls Find (and point out) common ground Understand your counterpart s perspective Work to shape their decision Allow the other side to save face Get them to think it was their idea! Negotiation Conflict Resolution 70
62 Process of Negotiation - When You Need Help Seek assistance from a trusted colleague or supervisor Refer to hospital bylaws and policies Contact Human Resources Call in mediator (or arbitrator) Walk away Don t bring it home Negotiation Conflict Resolution 71
63 Summary Points Conflict is inevitable Do your homework Identify personal attributes Avoid emotional investment Listen carefully to what is said Don t burn bridges Understand your BATNA (and theirs) Practice principled negotiation Negotiation Conflict Resolution 73
64 Final Remark Successful conflict resolution can be challenging because it has so many elements and possibilities, yet it undeniably plays a large role in an emergency physician s daily and career activities. Negotiation Conflict Resolution 74
65 National Residency Leadership Curriculum Questions?? Negotiation Conflict Resolution 75
66 National Residency Leadership Curriculum Special Thanks! Funded By: An American College of Emergency Physicians Chapter Grant Endorsed By: American College of Emergency Physicians Emergency Medicine Council of Residency Directors Emergency Medicine Resident s Association Society for Academic Emergency Medicine Negotiation Conflict Resolution 76
67 National Residency Leadership Curriculum Special Thanks! Senior Editors: Stephen Wolf, MD, FACEP Andrew French, MD Matthew Mendenhall, MD, MPH Tenet Editors: Britney Anderson, MD Barbara Blok, MD, FACEP Jeffrey Druck, MD, FACEP Maria Moreira, MD Lee Shockley, MD, MBA, FACEP Administrative Editor: Barbara Burgess Negotiation Conflict Resolution 77
68 National Residency Leadership Curriculum Thank You! For More Information Please Visit: Negotiation Conflict Resolution 78
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