Conflict Resolution Daniel R. Ouellette MD FCCP Henry Ford Hospital ACCP Spring Leadership Meeting February 28, 2013
Potential Conflicts of Interest None within the last three years
Who Am I? I am not an academic expert in this subject. Leadership roles: Retired Colonel, US Army Former PD Academic clinical faculty ACCP roles: Council of Governors, BoR, Networks, Guideline Oversight Committee Resources: Renegotiating Health Care by Marcus, Dorn, and McNulty, 2 nd Edition, 2011
The Admission A 65 year old man is evaluated in the ED with shortness of breath and chest pain. History: Severe COPD Exam: Wheezing CXR: COPD EKG: ST elevation precordial leads Troponins: Modestly elevated
ER Resident: Disposition, Disposition, Disposition The Admission
Cardiology Fellow: Heart the main problem? What will my attending say? The Admission
MICU Fellow: Why is the MICU the dumping ground for everyone else s patients? The Admission
Hospital Administrator: Let s keep that census up! The Admission
ED Nurse: Who will take care of my patient? The Admission
The Admission Each individual has a different perspective Limited direct interaction between individuals Ambiguous goals: high level of benefit Winning: winning individually?, winning for your group?, winning collectively?, winning for the patient?
Nature of Conflict Understanding the conflict is the first step on the road from competition and winning to negotiation and resolution. Good conflict Exposes problems Generates creativity Opens possibilities Problem focused Bad conflict Distracting Costly Adversarial
Ambiguity and Conflict Information present that is interpreted in different ways by persons depending on their knowledge, values, and life experiences. Important informational elements are not equally present to all stakeholders. Uncertainty exists about outcomes and options.
Complexity and Conflict: Persons involved or affected Persons present Physicians Nurses Patients Ancillary support services Persons not present Attendings Administrators Policy makers Insurers Family The greater the number of persons involved or effected by the circumstance, the greater the potential for conflict.
High Stakes! Life and death Financial responsibility Quality of Life Pain Legal ramifications Personal or professional pride Departmental politics
Conflict out of control STRESS FAMILY TIME? HUNGRY NO TIME PRIDE MISTRUST FATIGUE $$$ LAW SUIT $$$
Changing the Attitude: Accept Conflict Conflict is inevitable Complex decisions Different perspectives Large numbers of stakeholders What decisions need to be made for the pneumonia guideline? Who makes them? What are the different perspectives of the persons involved? Who are the stakeholders?
Changing the Attitude: Accept Conflict Conflict has functional advantages Identification of real problems Interactions may occur which lead to solutions What are the underlying issues for the MSS that apply to a broader context? What types of interactions might lead to solutions? Who should be brought into the discussions?
Changing the Attitude: Accept Conflict Conflict is a social phenomenon People are involved in the interaction The manner of expression becomes important What personal motivations are involved for the MSS leaders? Consider how the nature of the personal interactions between MSS leaders could be either constructive or destructive for the process
Changing the Attitude: The Consequences of Unresolved Conflict Damaged professional relationships Impaired leadership relationships within MSS Costs of time and money Interdivisional rivalries Damaged relationships with patients Poor quality medical care Increased cost of the pneumonia guideline Problematic inter-society relationships Diminished end-user confidence in the product (practitioners, patients)
Changing the Attitude Motivations of stakeholders Costs of continued conflict Compromise must be preferred to continued conflict by all parties Unwillingness to compromise related to anger, strategy
Changing the Attitude Conflict as a learning opportunity Each side often has much in common Each side has some measure of validity to their position Learning about and awareness of commonalities and differences enhance the willingness to negotiate
Changing the Attitude Misperceptions Every person has a story Is the conflict about the message, or how the message is being sent? Conflict consists of polarization and simplification by the participants.
Changing the Attitude Conflict is typified by two choices: win or lose! Reconciliation involves discarding the villain image of the adversary and seeking commonalities.
Changing the Attitude Consider the possibilities Continued conflict with waste of money and time (no guideline or poor quality product) Conflict resolution with resultant rewards (successful guideline with the stage set for future guidelines, income from spinoff products, etc)
Changing the Attitude Find a common purpose The idea of developing a high quality guideline benefits all parties
Changing the Attitude Anticipate Conflict Identify overall strategy Identify differences that might exist in perspectives How do we negotiate to minimize disruption? How do modify structure or policy at an organizational level to minimize conflict? How can we learn from conflict?
Changing the Attitude Use leadership to change the nature of conflict. Identify and describe the big picture. Develop a vision of the future with the conflict resolved. Use negotiation techniques to achieve the vision.
Conflict Resolution by Negotiation Explicit negotiation: Bargaining to reach a clear decision. Implicit negotiation: Involves unspoken assumptions, motivations, and inducements. Information exchange. Exchange of social authority, responsibility, authority, recognition.
Conflict Resolution by Negotiation Negotiation as discovery (curiosity and questions). Would it have been more effective for Dr. Matthews to ask Dr. Simpson about the nature of the agreement rather than chastise him for seeking it? Social hierarchy often impedes effective negotiation.
Conflict Resolution by Negotiation Negotiation as process (fluid rather than straight line). Not always A to B to C: Exploration may reshape the process. What if the ESS wishes to use the MSS product for several countries, and has already overcome obstacles?
Conflict Resolution by Negotiation Negotiation as power: three strategies Conservation of Power Dr. Matthews statement concerning authority Seeking Power Dr. Cartwright s statement about his Network s role Empowerment, which adds to the total power Dr. Matthews asks Dr. Simpson and Dr. Cartwright to meet with Dr. Pamukov to learn more about Belaslovakia s needs.
Conflict Resolution by Negotiation Interest-based Win-win Integrative; create a bigger pie Partnership with ESS and NSS will lead to greater rewards for all Shared interests Positional bargaining Win-lose Zero sum game; bigger piece of the pie for me Compete with ESS and NSS for rewards Own interests
Understanding Your Frame or Perspective People Primary Secondary Tertiary Problems History Strategy Cooperators (win-win) Collaborators (group win) Contenders (win-lose) Outcomes Zero sum Negative sum Positive sum Priorities Stakes
Conflict Resolution by Negotiation Understand your frame Understand other negotiators frames Problem: Different frames lead to incongruity and conflict Solution: Reframe to find congruity and solutions
Conflict Resolution by Negotiation Reframing using language: change but to and. I wanted to take part in the conference call but I could not. Incongruous statement with both yes and no. I wanted to take part in the conference call and I could not. Congruous statement suggesting a balance between competing priorities.
Reframing by language: Turn an obstacle into an action plan We may need to involve the ESS in the project, but we don t have a relationship with them. We may need to involve the ESS in the project, and we don t have a relationship with them. Contracts with the ministry of health will be needed but they will have to be approved by the State Department. Contracts with the ministry of health will be needed and they will have to be approved by the State Department.
Conflict Resolution by Negotiation Reframe by active listening Reframe by responding and engaging Reframe with negotiation face-saving Dr. Matthews suggests to Dr. Cartwright that this is the initial presentation of the proposal, and it is the first time that anyone has heard of it. Dr. Matthews tells Dr. Cartwright that he was invited to this meeting so that he could help develop the plans going forward.
Interest-based negotiation: Walk in the Woods Interest-based negotiation versus positional bargaining. Phrase stems from a Cold-War era anecdote. Used by Marcus and colleagues to describe a model of interest-based negotiation for seemingly unsolvable problems.
Walk in the Woods Negotiation Model PROBLEM SOLUTION Self-Interests Aligned Interests Enlarged Interests Enlightened Interests
Walk in the Woods Negotiation Model Dr. Matthews and Dr. Cox are the respective presidents of the MSS and NSS. The two societies have competed for membership and turf for years. Cooperation on the Belaslovakia telemedicine project seems unlikely. Dr. Matthews and Dr. Cox meet for dinner during a national forum. Dr. Matthews seeks access to the European community. Dr. Cox would like to develop telemedicine assets. (Self-interests)
Walk in the Woods Negotiation Model Dr. Matthews and Dr. Cox chat about their families and medical education. They have much in common. Their conversation turns to their visions for global health. (Enlarged interests) Dr. Matthews mentions the MSS charitable foundation and their work in Africa. Dr. Cox talks about the NSS expert tuberculosis survey team deployed to Asia. The two begin to brainstorm about future projects. (Enlightened interests idea of the no-commitment zone).
Walk in the Woods Negotiation Model Dr. Matthews and Dr. Cox start to discuss the idea of a complementary combination of the expertise of the two societies in the domains of education, telemedicine, charitable works, infectious diseases, and research efforts for improved global health. (Aligned interests) The MSS and the NSS announce the World Initiative for Global Health in the following year. The Belaslovakia telemedicine project is one of many facets of this initiative.
ACCP Leadership!