within SCCM across the board. He is going to be talking to us about conflict resolution. Thank you. Good morning, everybody. We're going to talk about conflict resolution and start by disclosure, which I don't have anything to disclose. The objectives are fairly straightforward. To describe steps for conflict resolution when conflict is of a legal nature. In the middle of the talk, it's only one slide because it's not the most common type of conflict we run into, but it is something you should be able to walk away and understand in contracts and other things that are part of impact you in your career, how to negotiate, and how to think about it, and how the other side might be bringing material to the table. We're going to talk interspersed about how conflicts can be constructive. That might catch you off guard. The word connotations are all negative, but they're actually positive aspects of conflict when managed correctly. And we'll be asking questions for you to be able to develop an effective strategy. So conflict can be constructive. Sometimes people call this managed conflict as opposed to constructive conflict. This is where we may completely disagree. We may get heated without losing our professionalism, and we all contribute. In fact, the reason this can be so good and so positive is that too often in health care, we get into what's called groupthink. Somebody in the room makes a comment. Everybody does this number with their head. The person at the lead thinks everybody agrees, and then we move on with that decision, and we make all sorts of mistakes downstream as opposed to potentially going around the room and hearing from everybody and discovering that, in fact, we disagree about a lot of it, and we need to come up with a strategy to get to a better solution that doesn't get us into trouble through groupthink. What we think most commonly of conflict is destructive conflict, and that's what involves antagonism and not resolution. Unfortunately, some would say conflict is unavoidable. The real issue is if it's managed poorly, it can be negative, and that can impact patient and family care so your conflict can be with the patient and the family. Or most commonly, our conflict is internal to the institution and across teams, and we'll talk about that as we go forward. So to be successful, you have to have a mitigation strategy and understand what are the tools you can use to try to resolve conflict, and you have to be open-minded and be flexible, or else you won't get anywhere in this issue. I wanted to just start with an image and get you to pause for a second and think about what these images evoke for you. Common medical environment. Somebody potentially screaming at somebody else. Somebody using gestures at somebody else that you see through the hallway, and what does that communicate to you? And then just the headache and difficulty of dealing with that difficult person who's having a bad day. We'll talk about all of those in just a second. So the first thing you have to do is you have to think about what's causing the conflict that exists. Is there a misunderstanding? We'll talk about some tools and some thoughts that you can use to try to get that clarified. Is it secondary to poor communication? Because that has a different strategy of how you might intervene. Are there differences in values and goals? Are you even understanding what the values and goals of the individuals you're having the conflict with are? Is this a personality issue? And is this secondary to the stress that you've heard a lot about this morning? I think many of you will look at those five things and say, how about all five together? It's a stressful environment with a person who tends to have a short temper, who I never clearly understand the values and goals, and they're getting upset frequently. And they don't communicate well to me. They walk off. And in the end, it's all a misunderstanding. So we say this all the time. I want to stress that this can happen. But a couple of times in this brief talk, I will come back to this idea that we too often don't deal with things when we need to deal with them, and then they build, what I call insidious summation. And you'll hear me talk about that in just a moment. How do we most commonly deal with a conflict circumstance? Well, the three most common ways that people deal with it are listed here. And none of these three are good. And they're the most common. We freeze, so we don't do anything. We turn our back and sort of walk away and just let it happen, and potentially even walk away from the circumstance. And or we may get verbally and or otherwise involved in the circumstance as well. These don't get us to resolution. All they do is amplify the conflict, or they delay the conflict. And in an environment where, and especially in a society so dedicated to team, then you really have to think about how the team is working and how the team can easily break down when you just delay and don't deal with it and just say, oh, well, that person's having a bad day. And then they have a bad day next Saturday, and they have a bad day the following Saturday, and we just let it continue. You saw this on the last talk, the Thomas Killman model. Actually, Thomas N. Killman created this for conflict resolution. The words are a little different depending upon whose resource you use to get there. So let me cover this very much briefer than I may normally have since Josh walked you through many of the aspects here. What we would call the x-axis is cooperativeness, and the y-axis is assertiveness. You want to end up in this far top right corner. The answer is collaboration. So you may want to pause. Did you expect the answer for conflict resolution is compromise? I just this morning had an email exchange with two past presidents of the society, and one of them said, well, you know about leadership. It's all about compromise. No. Compromise actually is not a great solution. It's better than avoidance. It's better than competing and fighting, but it's not the ideal. It is not collaborating and getting to a work-together solution. So this is a model that has significant benefit to you. It's been tested in multiple social and political environments. Let me point out the end of this tool in a slightly different way. And in this case, I'm going to use the word domination for competing. The domination, that top left corner of lots of assertiveness, that's a win-lose. If you accommodate, you're in a lose-win. If you avoid, everybody is losing because you're not dealing with solving the issues that you have. If you compromise, you win a little bit, you lose a little bit, they win a little bit, lose a little bit. We're taught to tolerate that and to accept that, when in fact, the way to get to a win-win is to collaborate. And so it's the top right corner of the Thomas Killman model that we really have to strive for. And the question is, what are some of the tools that you can use to get there? So the first, many of these are sort of tip slides. The first is five tips. Be respectful. I think that's obvious, but you'd be surprised how often people are not at the beginning of trying to get to conflict resolution. Stay in your lane. Don't start making comments and quotes that are way outside of what you know to be absolutely factual and what you know you're comfortable with and are fit you and what your abilities are. Be friendly. I love this. Or at least approachable. If you're already angry and you're already pushing back, you're just going to amplify the problem. Communicate clearly. Think about what you're saying and how you're communicating. We'll come back to this in a slightly different verbal approach in just a second. And always assume the best. Assume you can get to resolution. Assume you can get to collaboration. If you start off by saying, this person is, you know, this is a person with a bad personality and they're difficult to everybody and I'm going to have a problem, you're going to have a problem. You've got to really assume the best. I told you we'll get to legal. I'm going to show that on the next slide. It's a standard teaching in all business and legal schools. So I thought it was worth one slide. And then I'll come back to this insidious summation for a moment. So in legal negotiation, you start by investigating the circumstances. And you want to make sure you're prepared and potentially overprepared. And you spend time thinking about, how would I negotiate with myself? What are the questions that may get asked? And how am I going to answer those? And do I need to do more investigation to be more prepared? And then the famous legal and contractual phrase, BATNA, the Best Alternative to a Negotiated Agreement. In other words, in a legal sense, the only answer is to compromise. And people are going to get to this negotiated agreement. That's some compromise. Well, then you have to ask yourself, before you get into that, what would be my best alternative to that solution? You always want to have a comeback that's going to try to move the ball in a legal world, in a regulatory world. Once you have figured that out, you have to be ready to prepare to present your case. So that takes some time and effort. You have to think about how you're going to negotiate, in this case, the phrase bargaining, in order to get to, again, a compromise. And then you have to think about closure and potential follow up. In many legal circumstances, there's not. This is what you're going to learn if you go to a business class you're going to go to. It's not very helpful for conflict on the team. It's not very conflict for helpful with the team and the family. That's why I call it legal conflict resolution. And try to differentiate it from what I call insidious summation. Why do I call it that? I call it that because it not only leads to this, but why does it lead to this? It's because we didn't deal with it the first time. We avoided it. Then it was the second time, and we said the person's having a bad day. And then it was the third time. And there are some explosive circumstances can happen, especially in the ICU with family, potentially with other providers. But frequently, it's allowed to percolate and get a little worse and a little worse and a little worse until that summation of things leads to these sorts of responses. And if we had enough time and enough sort of space, we would ask you, which one of these do you relate to? And why? Connect it again to that last talk, which you may not have first thought that that talk and this talk would be so connected, but they are. So what are some of the strategies? The first is don't avoid. Don't ignore conflict. Figure out how you're going to deal with it and address the issue. You have to clarify the issue. I'll give a couple of comments on that. I'll come back to that. You have to come together to discuss. I'll come back to that as well. You're looking forward, so you're trying to identify solutions. And then you have to have a system of monitoring and follow up. So these are the sorts of things you want to have as a checklist in your mind for what's your strategy and how you're going to go about each of these bulleted items. Comment one, a neutral space for the conversation is frequently needed. This could be going to somebody's office, but it's definitely not the hallway. It's definitely not around a patient room. And anywhere near the clinical environment may be problematic, because one of the people involved in the conflict may be worried about just the fact that the two of us are walking to a room after people may have thought there was a conflict is going to add certain perceptions of who we are, et cetera. So you have to think about this issue and try to leverage it when you can. Start with a compliment, not false, not fake, but a real compliment if you can. Again, assume the best. You're trying to create a positive environment to get to collaboration. The third bullet is one we as humans do all the time. We say to ourselves, I know exactly why they did that. You don't have a clue why they did that. You're making all sorts of assumptions as a human, and then you react. And we do this in our families, and we do it in the work environment. You cannot emote for someone else. If you changed one thing today, and you change this, and every time you feel yourself beginning to emote for somebody, you said, wait a minute, I can't do that, you will open the door to say, oh, there are 15 other possible explanations here. And suddenly, you can start to try to work towards one of those. Listen and avoid preparing. This is a common mistake. I get the first four words out of my mouth, and you immediately are responding to think about, how am I going to argue back about that? How am I going to respond to that? And you stop listening. You're not really hearing what I'm saying anymore. We'll come back to a little trick you can do to try to help that as well. Focus on the problem, not the person. You heard that in the last talk as well. System issues, focus on the problem. That helps you focus on the future and not the past. You're not really trying to resolve the past. What you're trying to do is learn from it and be able to have a better system going forward. You need to control your emotions. I said that already. And the tone, I'll jump to the third one. Take it out, talk it out, and be face to face. Way too often, especially in today's world, we continue an email thread or a text thread. Everybody has their own sort of standard. Mine is, if we're on the third exchange and we haven't resolved the issue and we're trying to do it by email or text, it's time to put that down and go elsewhere. I even frequently find it at the first. But if you don't start off saying to yourself, I gotta monitor for this and think about it, you'll end up in the 10th and all sorts of misunderstandings will happen. Sorry for the unbelievably bad spelling here. Gestures with a G and a U. I'm talking about the, some of us come from cultures that are very hand and body oriented. And that's very important and we need to allow some of that. But the gestures that are used can be very indicative of the spinning of the pin, the shaking of the leg, and the tapping of the foot during the conversation. You know, pay attention to body language while you're trying to get to a situation to allow you to collaborate. You might need a mediator. That mediator could be an ethics committee. That mediator could be palliative care if it's patient and family oriented. The mediator may be the unit director or somebody else if it's between the teams. Apologize when you can and avoid but. Boy, do we do this all the time. I'm so sorry, I could have really handled this differently. But if you hadn't, but negates everything before the word but. You might as well not have said it because it's a lie. You don't believe it. So try not to use the word and. Apologize and say and I'm worried about. Okay? And you speak back. This one is just, you know, the talk back we talk about with patients sometimes, have the patient say back, what did you just learn? What did you hear me say? This is very frequent. What I hear you saying is, might be that you are hearing the person completely wrong. That they're having trouble communicating to you what the real issue is. And so you're there trying to solve problem A and they're there to fight about problem B. They may be still fighting about something that happened three months ago and you're trying to have a conversation about how to move forward from what happened this morning or yesterday. So very frequently you will see that this works really well. What I hear you saying is, one, you're signaling I'm listening to you. And two, it's very clear you're clarifying the issue and opening the door to be able to get to a collaborative solution. This is probably second, I think, most important piece of the talk. Insidious summation. We, they. How did we get to this point? Anesthesia didn't schedule a room. Anesthesia won't free up a resource. Surgery won't, interventional radiology says they won't get to this case for three days. We are a team and we're there to provide care as a team and the patients and families are expecting us and most are desirous of being part of that team and we spend the whole day finger pointing around the medical environment that there are all these problems and it's always somebody else. And we use this language. I think you really have to examine yourself. We are creating that negative vibe environment that doesn't allow what you heard in the last talk from Josh to take hold. It doesn't allow the humanities to be effective. It doesn't allow. It creates a profoundly negative, stressful environment that leads to and supports burnout as a conclusion, not supports effective resolution. Effective resolutions allow us to move forward. The third most major point I could make today is the power of questions. This works in medical care. This works in conflict. Ask questions. Don't say, okay, well, I'll measure the lactate every hour and I'll call you if it's above five. What lactate would concern you that you would want to know about so that I could give you a heads up early enough in the down spiral of this patient, right? Could ask a physician with a nurse in the ICU. So what did you think this rhythm was and why? Power of questions are unbelievable. They're better than statements. You see when you go to a meeting like this and we'll say, come to the mic if you have a question, sometimes when it's medical science being presented, somebody comes up and they're almost finger wagging. They're there to make a statement. And what do you think about this in the context of the article by Dorman in 1942 that they're not there to ask a question, they're there to make a statement. So ask questions, listen to the responses, pay attention to body language. Questions allow you to discover other people's perspectives and that allows you to open the door for being able to get somewhere with the problem that exists. So if I was gonna summarize, there are constructive criticisms, constructive conflicts that can happen, encourage those. Encourage people to talk to each other and to communicate openly and professionally. And it's real simple. Avoid destructive conflict. Spend time communicating with each other. Stop the background noise in the medical environment of the we, they. Focus at we, right, and then utilize some of these tips when conflict does occur. Thank you very much. Thank you.

conflict resolution

healthcare setting

open communication

problem-solving

collaboration