handling workplace conflicts: balancing our talking … · handling workplace conflicts: balancing...

5/21/2014

© University of Washington School of Nursing ‐ UWCNE.ORG 1

Handling Workplace Conflicts: Balancing Our

Talking with Thinking

Sara Kim, PhDResearch Professor, Surgery

Director of Educational Innovations and Strategic Programs, ISIS (Institute for Simulation and Interprofessional Studies)

Context of My Talk

Conflict in healthcare: Occurs at multiple points during various

patient care stages Frequently left unrecognized, unaddressed

and unresolved Can profoundly undermine the morale of

individual providers, teams and organization Ultimately, it can harm patients

Session Objectives

1

2Discuss effective strategies for

engaging in conflict conversations.

Describe key contributing factors to both task- and relational based conflicts

in healthcare settings.

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1 2 3

UW Medicine Conflict Study

Conflict-Handling

Skills

Let’s Practice:

Application of Skills

Session Overview

1. What contributed most to triggering the conflict?

2. Could it be possible that you might have contributed to

initiating, escalating, or prolonging the conflict?

Reflection

Silence Kills (American Association of Critical Care Nurses & Vital Smarts, 2005)

Broken Rules

Mistakes

Lack of Support

IncompetencePoor Teamwork

Disrespect

Micromanage

TurnoverTurnover

SatisfactionSatisfaction

Pt SafetyPt Safety

QualityQuality MedicalErrors

MedicalErrors

CommitmentCommitment

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Cost of Workplace Conflict

Data Source: Workplace Conflict And How Businesses Can Harness It To Thrive, CPP, July 2008; William G. Bliss—Bliss & Associates

Average Employee Spends 2.8 hours/wk= $359 Billion

Replacement cost =150% of the Lost Staff’s Annual Salary

25% of Employees

Illness, Absence

10% of Employees Project Failure

Entrenched Conflict at Workplaces: Promoting Patient Safety Using an

Experiential Training Model

Funded by UW Medicine Patient Safety Innovation Programs (PSIP)

1 2 3

StructuredInterviews

SimulatedConflict-Handling

Encounters

E-learning Module Design

Study Components

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Elizabeth Buttrick, Manager, Program Operations, ISIS

1

Lindsay Boyd, RN, Cardiothoracic ICU, UWMC

Elise Frans, RN, Wound and Ostomy, UWMC

2

Isaac Bohannon, Program Director, Otolaryngology

3

4 Ryan Fehr, Assistant Professor, Foster School of Business

Sarah Shannon, Associate Professor, School of Nursing

5

6

PSIP Team Members

MD/NP/RN/Allied Health

Providers (UWMC, HMC,

NWMC)

Patient &Family Advisory

CouncilMembers(UWMC)

Target Interviewee Groups

UW MedicineLeaders

(UWMC, HMC)

Interviewees

Interview Questions

What work patterns affected healthcare team?

1

What contributed to the initial conflict?

What were your major patient care concerns?

2

What was the conflict regarding and who was involved?

3

4

How did or did not the conflict resolve? 5

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Recruited: n=108

Completed: n=94

Response Rate: 87%

Status: Interviews

Interviewees by Role

MD/NPn=40

Nurse, Allied Healthn=33

Leadersn=13

Patientsn=8

Status: Interviews

1

2

3

161 Unique Stories Collected

11 Specialties Represented

12 Residents (13.8% of Total)

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Conflict Over Procedure, Policy, Standard of Care

Interpersonal Frictions, Bad Behavior

Type of Conflict

ConclusionType of Conflict

ResourceDepletion

PowerDifferential

NegativeWhat

TriggersConflict?

Org.Structure

Communi-cation

Breakdown

De-humanization

Compe-tency/

Integrity

Self-Focus

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Consequences of Conflict

Morale

Entrenched Perception

Circumnavigate

Staff Confidence

Resource Allocation

StandardsImprovement

IndividualProvider

Organi-zation

Patient

Team

Isolation, Self-Doubt

Coping Strategies

Job Satisfaction

ProlongedHospital Stay

No timely care

Guilt, Confusion

“Take the conflict out of my earshot!”

“Be objective. Stick to the medical facts and opinions. Leave out personality issues in the conversation with patients.”

Attribution Errors

Attribution Errors

Her English is not good.He is known

for his bad temper.

The main culprit of

escalating the conflict was attending’s

emotion.

The resident The resident didn’t

appreciate teaching moments.

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Know Your Conflict Management Style

Thomas-Kilman Conflict Mode Instrument

Source: https://www.cpp.com/products/tki/index.aspx

Thomas-Kilman Conflict Mode Instrument: COMPETING


Out there to win

Exert power, rank, authority

Assertive

Uncooperative

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Thomas-Kilman Conflict Mode Instrument: ACCOMMODATING


UnassertiveCooperative

Yielding to other’s Position (against own will)

Other’s concern >Own concern

Thomas-Kilman Conflict Mode Instrument: AVOIDING


Unassertive

Uncooperative

Withdraw from threatening situations

Sidestepping orpostponing issues

Thomas-Kilman Conflict Mode Instrument: COLLABORATING


Solution seeking

Assertive & Cooperative

Concerned about underlying needs & mutual interests

Explore disagreementsto seek insights

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Thomas-Kilman Conflict Mode Instrument: COMPROMISING


You give up something,I will give up something.

Mildly Assertive & Cooperative

Prefer expedient, middle ground solutions

Thomas-Kilman Conflict Mode Instrument


Conflict Handling Skills

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In your experience, what is most difficult for you when

handling workplace conflicts?

Reflection

Conflict Management Skills

Common Ground

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Perspective TakingCognitiveSkills

EmotionalSkills


BehavioralSkills

Empathize

Handle Own Emotion

Avoid Escalation, Gossip, Retaliation

Initiate Dialogue

Establish Mutual Goals

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Perspective Taking

Perspective Taking

Check for Bias

Hold Judgment

Ask Questions

Mirror What You Hear

Agree on Steps Forward

1

2

3

4

5

Emotion Handling

Separate Emotions from Facts

Focus on Behaviors

Establish Goals for Moving Forward

Communicate Feelings Appropriately

Create Mutual Expectations

1

2

3

4

5

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Emotion or Fact?

She was disrespectful to

me.

She was disrespectful to

me.

My manager is targeting me.

She gave me a bad evaluation.

My manager is targeting me.

She gave me a bad evaluation.

I felt demeaned.

I felt demeaned.

My professional judgment was

questioned.

My professional judgment was

questioned.

Avoid Pitfalls

Perspective Taking

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Restore Dialogue!

Institutional Resources

Conclusion

Conflict is part of our lives.

If handled timely and effectively, conflicts can lead to constructive outcomes.

Let’s create positive ripple effects at UW Medicine!

5/21/2014


THANK YOU!

Contact Information:

[email protected]

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