Conflict Resolution. A Core Leadership Attribute Seminar on Negotiation

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

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Intensity Course of Conflict Stalemate Communication Failures & Conflict Escalation Negotiation & Conflict Resolution Time Negotiation Conflict Resolution 4

Outline Definitions & Relevance Types & Factors of Conflict Conflict Resolution Keys & Principles Barriers The Art of Communications Process of Negotiation Negotiation Conflict Resolution 5

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

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

Negotiation DEFINITION A dialogue intended to: Resolve disputes Agree upon course of action Bargain for advantages Satisfy various interests Negotiation Conflict Resolution 8

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

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

Relevance - For Emergency Medicine Salaries & Schedules Positions & promotions Patient care Interpersonal interactions Medical legal protection Professional satisfaction Career security Negotiation Conflict Resolution 11

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

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

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

Conflict is Inevitable Negotiation Conflict Resolution 15

Why Do We Conflict? Personal differences Information deficiency Role incompatibility Environmental stress Negotiation Conflict Resolution 16

Types of Conflict Intrapersonal Interpersonal Intragroup Intergroup Negotiation Conflict Resolution 17

Types of Conflict - Intrapersonal conflict Conflict within Example Conflict in dealing with a particular type of patient Negotiation Conflict Resolution 18

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

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

Types of Conflict - Interpersonal conflict Conflict between 2 persons Example Conflict with a patient s family member or nurse Negotiation Conflict Resolution 22

Factors in Conflict Personal Attributes Gender Ethnicity/Culture Negotiation Conflict Resolution 23

Factors in Conflict - Personal Attributes Keirsey s 4 Temperaments Negotiation Conflict Resolution 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

Factors in Conflict - Gender Negotiation Conflict Resolution 29

Factors in Conflict - Gender Negotiation Conflict Resolution 30

Factors in Conflict - Ethnicity & Culture Language Behavior nuances Negotiation style Passion Tempo Culture Custom Negotiation Conflict Resolution 31

Conflict Resolution How do we get there? Negotiation Conflict Resolution 32

Conflict Resolution - The keys & principles Gain insight Truth always Seek wisdom Never criticize Offer assistance Negotiation Conflict Resolution 33

Conflict Resolution - The keys & principles * Garmel GM. Conflict Resolution in EM. In Adams Emergency Medicine (Elsevier), 2008. Negotiation Conflict Resolution 34

Conflict Resolution - The keys & principles * Garmel GM. Conflict Resolution in EM. In Adams Emergency Medicine (Elsevier), 2008. Adapted from Ahuja J, Marshall P. Conflict in the emergency department: Retreat in order to advance. Can J Emerg Med 2003;5:429-433. Negotiation Conflict Resolution 35

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

Conflict Resolution - Barriers Cynicism Criticism Comparing Competing Complaining Contending Negotiation Conflict Resolution 38

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

The Art of Communication Effective Communication is essential for Conflict Resolution Negotiation Conflict Resolution 45

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

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

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

The Art of Communication Negotiation is the art of letting them have your way. - Daniel Vare Negotiation Conflict Resolution 49

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

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

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

Process of Negotiation - Outcomes I Win Win/Win Lose/Win You Win You Lose Win/Lose Lose/Lose I Lose Negotiation Conflict Resolution 54

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

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

Process of Negotiation - Responses Negotiation Conflict Resolution 57

Process of Negotiation - Styles Negotiation Conflict Resolution 58

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

Process of Negotiation Focus on the issues, not positions Negotiation Conflict Resolution 60

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

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

Process of Negotiation - Barriers Emotions Fear & Anger Difficult Questions Difficult Personalities Complex Situations Negotiation Conflict Resolution 63

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

Process of Negotiation - Barriers: Difficult Questions Defer Deflect Delay Decline Negotiation Conflict Resolution 65

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

Process of Negotiation - Barriers: Complex Situations Repeat over time Multi-issue Multi-party Intangible factors Intra-organizational Tangible factors Negotiation Conflict Resolution 68

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

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

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

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

National Residency Leadership Curriculum Questions?? Negotiation Conflict Resolution 75

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

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

National Residency Leadership Curriculum Thank You! For More Information Please Visit: www.denverem.org www.coacep.com Negotiation Conflict Resolution 78