negotiation – conflict resolution 1 conflict resolution a core leadership attribute seminar on...

Negotiation – Conflict Resolution 1

Conflict ResolutionA Core Leadership Attribute Seminar on Negotiation

Created By:Gus M. Garmel, MD, FACEP, FAAEM

Clinical Professor, Department of SurgeryCo-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 MedicineUniversity of Colorado School of Medicine, Aurora, Colorado


Course of Conflict

Stalemate

Communication Failures & Conflict

Escalation

Negotiation & Conflict Resolution

Time

Inte

nsi

ty


Outline

• Definitions & Relevance• Types & Factors of Conflict• Conflict Resolution

– Keys & Principles– Barriers

• The Art of Communications• Process of Negotiation


Conflict

• 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.

DEFINITION


Conflict Resolution

• 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.

DEFINITION


Negotiation

• A dialogue intended to:

– Resolve disputes

– Agree upon course of action

– Bargain for advantages

– Satisfy various interests

DEFINITION


RelevanceModel of the Clinical Practice of Emergency Medicine*

*Created through collaboration of ABEM, ACEP, CORD, EMRA, RRC-EM, and SAEM

COMMUNICATION AND INTERPERSONAL SKILLS ISSUESComplaint ManagementConflict ResolutionInterdepartmental and Medical Staff RelationsTeam BuildingTeaching


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


Relevance- For Emergency Medicine

• Salaries & Schedules• Positions & promotions• Patient care• Interpersonal interactions• Medical legal protection• Professional satisfaction • Career security


Relevance- Example

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.”

E G


Relevance- Example

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.

E G


Relevance- Example

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.

E G


Conflict is Inevitable


Why Do We Conflict?

• Personal differences

• Information deficiency

• Role incompatibility

• Environmental stress


Types of Conflict

• Intrapersonal

• Interpersonal

• Intragroup

• Intergroup


Types of Conflict- Intrapersonal conflict

• Conflict within• Example

– Conflict in dealing with a particular type of patient


Types of Conflict- Intragroup conflict

• Conflict between individual group members

• Example– Your colleague always grabs the sickest

patients and major resuscitations


Types of Conflict- Intergroup conflict

• Conflict between 2 groups of people

• Example– Who performs the ED thoracotomy in a

trauma resuscitation (EM vs. Surgery)


Types of Conflict- Interpersonal conflict

• Conflict between 2 persons• Example

– Conflict with a patient’s family member or nurse


Factors in Conflict

• Personal Attributes

• Gender

• Ethnicity/Culture


Factors in Conflict- Personal Attributes

• Keirsey’s 4 Temperaments


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


Factors in Conflict- Gender


Factors in Conflict- Ethnicity & Culture

• Language• Behavior nuances• Negotiation style• Passion• Tempo• Culture• Custom


Conflict Resolution

How do we get there?


Conflict Resolution- The keys & principles

• Gain insight

• Truth always

• Seek wisdom

• Never criticize

• Offer assistance



* Garmel GM. Conflict Resolution in EM. In Adams Emergency Medicine (Elsevier), 2008.



* 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.


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. non-

negotiable• Pride


Conflict Resolution- Barriers

• Cynicism• Criticism• Comparing• Competing• Complaining• Contending


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


The Art of Communication

Effective Communication is essential for

Conflict Resolution



• 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 !



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…


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 is the art of letting them have your way.

- Daniel Vare



Let us never negotiate out of fear - But let us never fear to negotiate.

- President John F. Kennedy


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


Process of Negotiation- Objectives

• Mutually satisfactory structure• Executed agreement• Lasting and mutually beneficial

relationship• Comfort with process and outcome• Accounts for feelings


Process of Negotiation- Outcomes

Win/Lose

Win/Win Lose/Win

Lose/Lose

I Win

I Lose

YouWin

YouLose


Process of Negotiation- Steps to success

• Have a plan• Broad to narrow• Actively listen & learn• Take notes• Unbundle issues• Paraphrase don’t parrot


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


Process of Negotiation- Responses


Process of Negotiation- Styles


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


Process of Negotiation

Focus on the issues, not positions


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


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


Process of Negotiation - Barriers

• Emotions– Fear & Anger

• Difficult Questions

• Difficult Personalities

• Complex Situations


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


Process of Negotiation - Barriers: Difficult Questions

• Defer

• Deflect

• Delay

• Decline


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


Process of Negotiation - Barriers: Complex Situations

• Repeat over time• Multi-issue• Multi-party• Intangible factors• Intra-organizational• Tangible factors


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!


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


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


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.


National Residency Leadership CurriculumQuestions?

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National Residency Leadership CurriculumSpecial Thanks!

Funded By:An American College of Emergency Physicians Chapter Grant

Endorsed By:American College of Emergency Physicians

Emergency Medicine Council of Residency DirectorsEmergency Medicine Resident’s Association

Society for Academic Emergency Medicine


National Residency Leadership CurriculumSpecial Thanks!

Senior Editors:Stephen Wolf, MD, FACEP

Andrew French, MDMatthew Mendenhall, MD, MPH

Tenet Editors:Britney Anderson, MD

Barbara Blok, MD, FACEPJeffrey Druck, MD, FACEP

Maria Moreira, MDLee Shockley, MD, MBA, FACEP

Administrative Editor:Barbara Burgess


National Residency Leadership CurriculumThank You!

For More Information Please Visit:www.DenverEM.org www.CoACEP.com

http://www.denverem.org/

http://www.coacep.com/

negotiation – conflict resolution 1 conflict resolution a core leadership attribute seminar on...

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