1 Identifying and Resolving Conflict: helping residents learn the basicsRAJ INTRODUCE SELVES ASK THE AUDIENCE TO INTRODUCE THEMSELVES (BY GROUP), DIRECTORS, FACULTY 2017 Annual STFM Conference Deborah Taylor, Ph.D. Donald Woolever, MD Central Maine Medical Center FMR
2 Our Goals Today Understand 2 reasons why residencies are conflict “petri dishes”; Recognize the role your family of origin plays in your approach to (or avoidance of) conflict; & Outline a strategy to incorporate conflict management training in your residency education curriculum. RAJ
3 What comes immediately to mind when I say the word Conflict?Free Association What comes immediately to mind when I say the word Conflict? RAJ TO QUERY – DEBORAH TO DOCUMENT ON FLIP CHART
4 The Basics divergence of opinion, incompatibility, clash, strife for mastery, a hostile encounter……Why does conflict occur? What is a major contributor to the development and maintenance of conflict? Runs the gamut (minor irritation…..intense battle) DEBORAH
5 Common MisperceptionsMYTH: Conflict is bad and to be avoided. REALITY: Conflict is a normal part of relationships. DEBORAH
6 Common MisperceptionsMYTH: Ignore it, and it will go away. REALITY: Escalates because the issues go unresolved. RAJ
7 Common MisperceptionsMYTH: All Conflict can be resolved. REALITY: Some conflicts have no acceptable resolution to both or all parties involved. DEBORAH
8 Benefits of Conflict Solves problemsEncourages goal and mission re-evaluation Stimulates necessary changes in relationships and systems Clarifies, builds and strengthens relationships Highlight and hopefully eliminates inequalities and injustices RAJ
9 When Conflict Goes UnmanagedConsumes/wastes time and energy Erodes trust and mutual support Breakdown of effective communication Fear, anger and vulnerability drive decisions Masks creativity and innovation Stalls or blocks change DEBORAH – BEFORE HEADING OFF OF THIS SLIDE, INTRODUCE THE CONCEPT OF WHERE OUR BASIC CONFLICT MANAGEMENT SKILLS COME FROM – OUR FAMILIES OF ORIGIN – ASK THEM TO CONSIDER WHICH OF THE 5 GENERAL APPROACHES TO CONFLICT RESONATE WITH THEM FROM THEIR FOO’s
10 FAMILY FEUD In which category does your family fall?I am afraid of conflict. In my family, conflict meant yelling and fighting which usually led to heartache or bad feelings. DEBORAH
11 FAMILY FEUD In which category does your family fall?In my family, we argued for fun. Outsiders often thought we were really fighting, but it was our way of showing that we cared about each other. DEBORAH
12 FAMILY FEUD In which category does your family fall?My parents rarely raised their voices to each other. I never knew that things were not going well until they announced they were getting a divorce. DEBORAH
13 FAMILY FEUD In which category does your family fall?The members of my family did not ever disagree until someone was REALLY angry. Then one little thing would put one or both of my parents into a screaming rage. DEBORAH
14 FAMILY FEUD In which category does your family fall?I I grew up in the only non-dysfunctional family in our town. We always openly and freely discussed any issue that bothered us. Calm, respectful discussion was the norm. DEBORAH
15 RAJ – LOTS MORE INFO BELOW TO HELP YOUANOTHER FRAMEWORK TO HELP RESIDENTS CONNECT WITH DEVELOPING DIFFERENT CONFLICT MGMT SKILLS FOR DIFFERENT TYPES OF SITUATIONS: What each style accomplishes and when this style might be useful – Competing – you try to satisfy your own concerns at the other person’s expense: When to use this: Quick, decisive action needed; Important but unpopular issues are at stake and where there isn’t “right” way Collaborating – You try to find a win-win solution that completing satisfies both persons’ concerns When to use: Both sets of concerns too important to be compromised; Needs insights from different perspectives Increases others’ commitment to solutions; Long-term major issues Compromising – You try to find an acceptable solution that only partially satisfies both persons’ concerns When to use: Moderately important goals but not worth potential disruption of more assertive modes; Two equally strong parties committed to mutually exclusive goals; Expediency; Back up competing/collaborating Avoiding – You sidestep the conflict without trying to satisfy either persons’ concerns When to use: Trivial issues; No chance of getting what you want; Potential risk of confrontation outweigh benefits of resolution; Other better places to resolve the issue Accommodation – You attempt to satisfy the other person’s concerns at the expense of your own. When to use: Issue much more important to other party; To limit damage of continued conflict; To bank favors; When in the wrong TKI (Thomas Kilmann Conflict Mode Instrument) – https://workshopbank.com/conflict-resolution-strategies
16 Two Basic Types of Conflict Task........vs.........RelationalTask Conflict: arises from a difference in priorities or goals or expectations related to the task at hand. Relational Conflict: arises from differences in work habits, values, communication styles & perception. Problem is power struggle, individual differences & history vs. the task at hand. DEBORAH
17 s for Relational ConflictThe issue is obviously not the real issue Irrational or counterproductive stands Unexplainable standoffs occur Folks sound and behave defensively Willing to risk entire relationship If it comes up over and over again…. DEBORAH
18 Continuous Evaluative Environment Pressure Cooker Constant Change Fatigue Anxiety Continuous Evaluative Environment Pressure Cooker Constant Change High ambiguity Need to make decisions quickly RAJ
19 6 Steps to Help Manage ConflictDEBORAH
20 Step 1 to Help Manage ConflictSeek to understand DEBORAH
21 Step 2 to Help Manage ConflictDiscuss face-to-face RAJ
22 Step 3 to Help Manage ConflictStick to the issues DEBORAH
23 Step 4 to Help Manage ConflictCheck your emotions & attitudes RAJ
24 Step 5 to Help Manage ConflictSpeak for yourself DEBORAH
25 Step 6 to Help Manage ConflictUse time to mutual advantage RAJ
26 Skills – Time to Exercise ThemSeek to understand Discuss face-to-face Stick to the issues Check your emotions & attitudes Speak for yourself Use time to mutual advantage REFER TO HANDOUT
27 Large Group Exercise some “hypothetical” situations for you to ponder…..DEBORAH YOU ARE FREE TO USE ANY OF THESE SCENARIOS WITH YOUR RESIDENTS AND MEDICAL STUDENTS. WE WLL GO THROUGH A COUPLE SO THAT YOU CAN SEE HOW TO OPERATIONALIZE THIS EXERCISE IN LARGER GROUP SITUATIONS.
28 Scenario #1 Exercise: 1. Gut Response - Task or Relational 2Scenario #1 Exercise: 1. Gut Response - Task or Relational What factors influenced your response? Run through the six steps You have been on call for 24 hours and are expecting Matt to relieve you at 0700 – he strolls in at 0740. DEBORAH
29 Scenario #2 Exercise: 1. Gut Response - Task or Relational. 2Scenario #2 Exercise: 1. Gut Response - Task or Relational What factors influenced your response? Run through the six steps Mary admits one of your favorite and prized patients while on night call. You have been working for months to get his HTN and diabetes under better control with good success. She signs out that she has changed all of your patient’s meds. DEBORAH
30 Scenario #3 Exercise: 1. Gut Response - Task or Relational. 2Scenario #3 Exercise: 1. Gut Response - Task or Relational What factors influenced your response? Run through the six steps Maude, your Practice Mgr, instructs the scheduler to double book all of your acute slots since you have a high no-show rate. DEBORAH
31 Scenarios #4 Exercise: 1. Gut Response - Task or Relational. 2Scenarios #4 Exercise: 1. Gut Response - Task or Relational What factors influenced your response? Run through the six steps The Program Director calls you into his office to discuss information s/he has just received from the Maternity Care nurses about you. DEBORAH
32 Scenario #5 Exercise: 1. Gut Response - Task or Relational. 2Scenario #5 Exercise: 1. Gut Response - Task or Relational What factors influenced your response? Run through the six steps You are on the senior resident on the Fam Med inpatient service. Your spouse sends you an at work expressing a desire to sit down and talk about some troubling relationship issues (like the fact that you are never home). DEBORAH
33 Scenario #6 Exercise: 1. Gut Response - Task or Relational. 2Scenario #6 Exercise: 1. Gut Response - Task or Relational What factors influenced your response? Run through the six steps Your child is in her first recital – you are on call that night. An sent to resident colleagues about trading yields no offers of help.
34 Small Group Exercise (to transport home to use)First, make a list of examples of task-type conflicts and relational-type conflicts in your residency program (yours or your knowledge of others) Break into small groups (2-4 people) Share these with each other (with the expectation of confidentiality attached) Observations? Differences…Similarities? Prepare a short report to the larger group. DEBORAH
35 RAJ
36 Summary Residency = petri dish You bring your family with youTask or relational conflict 6 steps to help you manage conflict
37 / Thanks for coming