Promoting a healthy work environment: Conflict resolution and disruptive behavior. Mansfield Mela

Transcription

1 Promoting a healthy work environment: Conflict resolution and disruptive behavior Mansfield Mela

2 CFPC CoI Templates: Slide 1 Faculty/Presenter Disclosure Faculty: MANSFIELD MELA Relationships with commercial interests: Grants/Research Support: NONE Speakers Bureau/Honoraria: NONE Consulting Fees: NONE Other: NONE

3 CFPC CoI Templates: Slide 2 Disclosure of Commercial Support This program has NOT received financial support from in any form This program has NOT received in-kind support Potential for conflict(s) of interest: NONE

4 CFPC CoI Templates: Slide 3 Mitigating Potential Bias NONE

5 Additional disclosure I have over 55,000 unread s Such inaction may have caused you, the sender, a leg and arm I expect you to set up a crucial conversation with me about my passive aggressive communication style I really should not have a Facebook account as the posts will remain unread

6 Road Map 1. Identify the common sources of conflict in the work place 2. Recognize behaviors that qualify as disruptive in 'all of us 3. Consciously estimate and effectively intervene over the negative consequences of conflict and disruptive behavior

7 Actions speak louder than words

8 The goal of a psychologically healthy workplace What disrupts the workplace! What restores the workplace!

9 Conflict or Disruption Have you or do you know a perfectionist who sets unattainable and unreasonable expectations for others? Have you or do you know a colleague who overreacted and harshly criticised other colleagues for lapses in conduct or performance?

10 What is conflict? The process which begins when one party perceives that another has frustrated or is about to frustrate a concern of his/her.

11 Conflict is a Normal part of life A conflict is a situation when the interests, needs, goals or values of involved parties interfere with one another. A conflict is a common phenomenon in the workplace A conflict may present opportunities for improvement and learning Conflict is the gunpowder of friction

12 Sources of workplace conflict

13 Differing Perception The meaning of life follows our interpretation Can be subtle or overt Superficial or deep e.g. a new addition to staff can be seen as a welcome help or as a message about incompetence Scarce resources, recognition and power The loss of the intended meaning

14 Conflicting goals The issue of the blind eight touching different parts of an elephant. If the goals are seen as disparate, unrecognised and in competition with others Quality versus quantity Selflessness versus selfishness

15 Pressures Deadlines by different sections of the industry consider a resident who is preparing for exams in two months and hopes to take a study holiday when his preceptor has to be presenting internationally and needs resident to cover. The duties of acting as a consultant is daunting because it is impossible to dedicate 100% attention to the task. At the same time the resident s mother has just received a terminal diagnosis and the resident has just begun using the new malfunctioning EMR

16 Try to resolve it

17 Many flavors of conflict resolution

18 Using a mood stabilizer

19 Call the conflict resolution helpline

20 Have a face off

21 The mothering way

22 At Trump Tower

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25 Communication and Collaboration

26 Communication Initiator receiver Messenger message What how Intent reaction Training - education

27 Fueling the conflict

28 Stories we tend to tell ourselves Picture something Imagine things Negative towards the person Victim stories I am the innocent victim Villain story he is evil Helpless story no power, no leverage RX- notice recount and change the relevant story

29 Prepare You are never persuasive when abrasive Your point won t come across by being cross If you say it offensively it will be received defensively Never use truth as a club (wrap it in love) Chose helpful and not harmful words - Rick Warren

30 Conflict resolution strategies

31 Approach Listen to their hurt, emotions and intent Look from the other s perspective as only when you understand them can you influence them circumstance, background Look at how far they have come and not how far they have to go. If I went through that I will not be as far along as they have gone Have a third party as last resort

32 When it cannot be resolved... Focus on reconciliation and not resolution, re-establish the relationship, be at peace with each other You can disagree without being disagreeable Unity without uniformity Walk hand in hand but not eye to eye

33 It is possible to have peace northern Ireland, South Africa, Berlin wall, wars etc

34 The 1914 Christmas Truce

35 Reasonable expectations Complies with practice standards. Uses conflict resolution skills in managing disagreements. Addresses concerns about clinical judgments with associates directly and privately. Communicates with others clearly and directly, displaying respect for their dignity. Participates in regular behavioural feedback. Supports policies promoting co-operation and teamwork. Is open to constructive criticism - Pfifferling 97

36 Disruptive behaviour by a physician The Canadian Medical Protective Association (CMPA)

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38 INCIVILITY Incivility is a lack of regard for others (Andersson and Wegner 2001) and has three identifiable characteristics. Incivility is: Psychological in nature; A form of low intensity, inconsiderate conduct; and Associated with an ambiguous intent to harm the target.

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40 Disruptive Behavior DB or inappropriate choices of behaviour is personal conduct (words, actions or inactions) beyond that normally accepted as respectful interpersonal behaviour which disturbs the work environment and/or potentially poses a risk to delivery of safe and quality healthcare. NATURE, CONTEXT, PATTERN AND CONSEQUENCES

41 The D - word The scalpel-throwing surgeons The macho go it alone physician Disruptive behavior is less tolerated 2-5% of physicians are disruptive 73% of residents experienced it Yelling shaming and condescension Residents involved as well (25%)

42 Example of overt DB 50 years old surgical specialist Strong patient focus DB Educational session Flood - incident reports Passed off on Chief Criticised openly Special needs son for killing my patient a racial epithet too old for residency go to medical school sexually degrading words. too fat to clean on call for surgery or are you on probation

43 Staff members Action Specialist s response Nursing staff I can t work with him She is not fit to work here since she can t contribute to patient care Nursing supervisor Change so that morale can improve Stop targeting me when I am doing my work Chief of Surgery Administrators We are friends but we need to address staff concern Set up panel to deal with this You are just a pawn for the hospital Typical you don t care about patients only fiscal matters

44 Subtle DB Persistent lateness Repeatedly refusing to comply with accepted policy Chronic refusal to collaborate with colleagues Failure to respond to calls for assistance - health quality council of Alberta 2013

45 Disruptive Behavior & Clinical Outcomes: Perceptions of Nurses & Physicians 1200 hospitals 4530 responses 25 item questionnaire 2846 nurses 944 physicians 40 administrators 700 pharmacists, respiratory technologists, laboratory technologists, physical therapists

46 Examples of healthcare workplace DB Rosenstein & O Daniel 08

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50 Consequences of DB Turnover (Rosenstein and O Daniel 2005) and turnover intentions increase (Donovan, Drasgow, and Munson 1998; Maxfield et al 2005) Nurses report disruptive behavior as an important factor in job satisfaction and morale and 31 percent of nurses said they knew of at least one nurse who had left an organization as a result of DB (Rosenstein and O Daniel 2005)

51 Absenteeism, commitment to organization Avoiding workplace aggression becomes both a practical decision and a means of self-protection from intimidation. Absenteeism Commitment and dedication to the Organization falters in the context of DB Loss in the impetus for creativity and innovation

52 More consequences Administrators, nurses, and physicians surveyed, between 53 percent and 75 percent of respondents reported a strong link between disruptive behaviors and the clinical outcomes of patient safety, errors, adverse events, and quality of care. Twenty-five percent of respondents reported a link between patient mortality and disruptive behaviors (Rosenstein and O Daniel 2005).

53 Disturbed workforce Insomnia and nightmares Sleep deprivation Impaired ability to focus Anxiety and depression Irritability affects communication and interaction. Low self-esteem Prolonged suffering 22 months for most victims Post-traumatic stress

54 Autonomous, high performing high achieving v. Lacking empathy, cold uncaring

55 High achieving, efficient v. Domineering intimidating, demeaning

56 Perfectionist, objective, hard working v self centered, critical

57 Competitive, successful v demeaning, critical

58 Contributory factors to DB Medical training expectations Organizational hierarchy Perfectionistic tendencies No weakness attitude Unclear roles and responsibilities Life happens Recent stress Distress Fatigue Anger frustration Competency communication and collaboration

59 The Rationalizing Advocate

60 The indispensable

61 Resting place of the indispensables

62 CISS Conduct actions, words or inactions Interpersonal real and imagined Standard beyond that normally accepted as respectful Safety Consequences disrupts work environment and poses a risk of safe delivery of care ALL FORMS!!

63 CATEGORIES OF DB

64 Disruptive behavior

65 Upset

66 Gossiping

67 aggression

68 Passive aggression

69 Retaliation and backlash

70 Silent treatment

71 Fight fair

72 What to do Preconception prevention Practice professionalism Condition of employment agreement Emotional intelligence assessment and intervention Strengthen the core resilience Reculturization of the healthcare workplace (reculturing versus restructuring)

73 The train has already left the station 73

74 Confidential reporting and consistent follow through

75 Attitudes must change Applauded Accepted Tolerated Ignored

76 Administration/Leadership Pre- Medicine End of Medical Career All of us Beginner Medicine Seasoned Practitioner Early Practice phase

77 Administration/Leadership Codify acceptable behaviour Lead attitude change from the top Hire for fit and personality Pre- Medicine End of Medical Carreer All of us Beginner Medicine Seasoned Practitioner Early Practice phase

78 -Realize advancement -Don t be the warning Pre- Medicine -Check difficult traits End of Medical career All of us Beginner Medicine -Right of passage event -Train in EI -Trainer -Comfort -Practice professionalism Seasoned Practitioner Early Practice -Resilience -Good self-care -Awareness -Mentor -Practice civility -Coach

79 Administration/Leadership All of us -Limit factors that contribute to DB -Empower each other to document and report -Support initiatives for healthy workplace -Practice Disarming statements -Engage in crucial corrections -Support colleagues returning to work -Develop and comply with codes of conduct -Be aware and conscious of behaviour -Detail the effect on others -Demand specific behaviour change -Seek professional help

80 PHP to the rescue Eliminating the individual root causes Deep personal values Cultural and religious upbringing Ethnicity Gender, Age Personality Training Life experience

81 Management Multifactorial Early detection and monitoring Assessment and diagnosis crucial communications Psychiatric follow up Involve family Restriction and license suspension/revocation

82 Emotional intelligence

83 Application Awareness of own and others emotions facilitates successful intervention Effective interpersonal communication contributes to such awareness and can be taught The moral and affective domains seek to evaluate social skills beyond clinical competence

84 Advantages of High EI Promote respectful, interpersonal interaction Verbal and non verbal communication Listening skills Negotiations Decision making assertiveness Problem solving

85 Be that one to... Encourage team members Be punctual at appointments Validate input of other team members Acknowledge others opinion as valuable Appreciate differences in the workplace

86 Civility can be taught, internalized and rewarded

87 Q A