Se ha denunciado esta presentación.
Utilizamos tu perfil de LinkedIn y tus datos de actividad para personalizar los anuncios y mostrarte publicidad más relevante. Puedes cambiar tus preferencias de publicidad en cualquier momento.

Article From Conflict Management to Healthcare Teams Effectiveness 2017

131 visualizaciones

Publicado el

Article From Conflict Management to Healthcare Teams Effectiveness 2017

Publicado en: Liderazgo y gestión
  • Sé el primero en comentar

  • Sé el primero en recomendar esto

Article From Conflict Management to Healthcare Teams Effectiveness 2017

  1. 1. From Conflict Management to Team Effectiveness in Healthcare Facilities: A Comprehensive Approach By Luis E. Ore, J.D. M.A., Consensus Building & Relationship Management Consultant This article attempts to describe the foundations for a proposed comprehensive approach to team effectiveness from a conflict management perspective using diverse frameworks to enhance teamwork performance in healthcare settings by “on-site” training. Considering the environment in which healthcare professionals interact, these professionals need to be in tune regarding how they interact in different situations and how they address challenges on a regular basis. Developing a framework to accomplish their goals can offer healthcare professionals some guidance about how to better interact while acting their roles, sharing their diverse expertise and facing their interaction as a constant learning experience. Lencioni (2005) affirms that teamwork can be achieved if teams overcome five dysfunctions: Absence of trust, fear of conflict, lack of commitment, avoidance of accountability, and inattention to results. Trust is a fundamental condition for teamwork, Lencioni (2005) affirms “When it comes to teams, trust is all about vulnerability. Team members, who trust one another, learn to be comfortable being open, even exposed, to one another around their failures, weaknesses, even fears”. (p.14). Therefore to build trust, more than time, teammates need courage - courage to be vulnerable. In order to have teams able to overcome the absence of trust, team members need to shift paradigms and adversarial mindsets. One way to accomplish this paradigms’ shift is through conflict management training. Everyone has experienced frustrating feelings when dealing with conflicting situations and the fact is that when dealing with conflict all of us have an instinctive reaction of whether to fight or flight. Therefore, learning about dealing with conflict and strategic choices can trigger strategic thinking in the way we interact with others. Conflict Management and Interest-Based Negotiation Conflict management training could start by transferring knowledge and expertise about the nature of conflict and the typical five strategies of dealing with conflict when assessing the weight of issues and relationship at stake. Considering the importance of continuous working relationships, the nature and purpose of teamwork, an emphasis on interest-based negotiations as conflict management skill might be salient; however, competitive strategies might be an option if the stakes are extremely high such as life or death and when timely response is an issue. Either way, a mutual gains approach or interest-based negotiation can be the first option, most of the time, if the healthcare professional decision-makers have a clear sense of their BATNAs (Best _____________________________________________________________________________________ * Luis E. Ore is founder of ORASI Consulting Group Inc., a training and development consulting firm specializing in negotiation, consensus building, relationship management, and conflict prevention. Ore assists businesses with cross-cultural and international negotiations, strategic alliances, organizational changes, dispute resolution system design, and foreign direct investment, especially between the United States of America and Latin-American countries. Ore has Masters of Arts degree in conflict management and in organizational communication, a J.D. from the University of Lima (Peru), and extensive training in negotiation and conflict management from CMI International Group, Western Kentucky University, Lipscomb University, and the Program on Negotiation at Harvard Law School. Ore was Chair of the Association for Conflict Resolution’s International Section and an active associate of the American Bar Association. He can be contacted via email:
  2. 2. Alternative to a Negotiated Agreement). Training healthcare professionals on interest-based negotiation skills might be the first building block toward achieving effective teams. If people know how to deal and walk through their differences they will likely succeed on reaching shared understanding which is crucial for working together. Training in interest-based negotiation will help team members move away from finger pointing and toward joint problem solving, improving communication processes and separating people from the problem. The interest-based negotiation approach is based on seven elements, including: interests, options, objective criteria (legitimacy), commitments, alternatives, communication and relationship. At the core are the interest of the team members - the underlying needs, concerns, fears worries, etc that motivate their positions on any issue, the brainstorming to create mutually beneficial options to satisfy those interests, and the use of standards or objective criteria to legitimize those options and to make acceptable a set of options beyond a simplistic contest of wills when dealing with differences. This interest-based negotiation training can shift participants’ mindset from adversarial to side-by-side negotiation. Beyond the strategic and rational analysis of negotiating about conflicting situations and focusing on interest, options and standards; the relationship (people) and communication elements of the interest-based negotiation framework deserve a deepest exploration and can be supported by additional frameworks. A Relationship (People) Framework Fisher and Brown (1988) developed a framework for building positive working relationships that enable people deal with differences. This is a strategy to be unconditionally constructive and to improve the process of people’s interaction. Fisher and Brown (1988) affirm the ability to develop and maintain effective working relationships depends on few basic elements: Rationality, understanding, communication, reliability, persuasion not coercion, and acceptance. 1. Rationality, understood as balance of emotion and rationality constitutes a requirement when dealing with others - too much emotion clouds judgment while too little impairs the motivation for understanding. This improves the relationship. 2. Understanding, reached by asking questions to learn people’s perspectives, reversing roles to see it from others’ view, and drafting a chart listing their perceived choices in the matter. This will facilitate more constructive and fair cooperation, if we treat others’ view as worthy of understanding. 3. Communication, this means that people should engage the other team members, speak clearly, and use privacy to avoid audience pressure over decisions. One person has to help the other’s active listening by having them repeat what the other has said. These strategies of interpersonal interaction constitute the base of the relationship - the key to unlocking understanding and to making the way towards a working relationship. 4. Trust, the authors affirm that predictability, clarity of communication, honesty, and honoring promises help the other person to open up and explain his or her interest. This prevents opportunities for mistrust, and people should seek ways to limit situations requiring blind trust. 5. Persuasion, which helps to attack the problem through reason, open communication, and honesty. Not using coercion - this relies on force that may “solve” the conflicting situation but does not improve the working relationship. 6. Acceptance, the authors mention the importance to accept that differences occur between people and that these differences can bring beneficial outcomes, so valuing different perspectives, the parties can open better channels of cooperation.
  3. 3. A Communication Framework Fisher, Ury and Patton (1991), and Fisher and Brown (1988) highlighted the importance of two- way communication when dealing with people and differences. In this line, Stone, Patton, and Heen (1999) developed a framework to understand and achieve effective communications and excel difficult conversations. The authors affirm that what it gets in the way of effective problem solving and what we can do about it rests in our own thinking. Our actions (external behavior) reflect our thoughts. All our perceptions are partisan and incomplete. The world is complex like a puzzle and we don’t have all the pieces. None of us know all of the truth. We all see the world with our own lenses which are framed and influenced by our own interests, own past experiences and own culture. As diverse regions of the planet and organizations around the globe have different cultures, it is fair to state that professionals from different fields have diverse cultures; every profession has its own culture. We all take in information with our own worldview and among healthcare professionals here several distinct professionals therefore; there are diverse cultures and worldviews in the healthcare industry. Then, in order to reach team effectiveness in healthcare settings, we need to be able to understand each other’s views and be open to seek understanding of each other’s culture, and create a new culture while working together. Stone, Patton, and Heen (1999) suggest using a “ladder of inference” tool to explore differing perceptions and to explore each other’s reasoning. The three steps of “ladder of inference” are the facts that we notice, our interpretations of those facts and our conclusions based on our interpretations, this explain our views. Our actions reflect our thoughts and our thoughts are problematic, but our thoughts can be shifted. We can move away from over confidence in our perceptions (I know what happened and I’m right) toward a mindset that believes there may be more than one way to see a situation. Away from all-or-nothing thinking or blaming mindset (the other is to blame) toward a thinking that states that probably each of us has contributed in some way to what happened. This moves the parties dealing with a difficult conversation from blame games to contributory systems that understand that many factors contribute to the result of any situation. Our thoughts can be shifted from an assumption that we know the other people’s bad intentions (attributing bad intentions) toward a way of thinking that highlights that we are not sure what the other people are trying to accomplish, and we would like to find out – we can always try to test attributions. For effective two-way communication is crucial to share views and conclusions as hypothesis instead of judgments and explore the information (data) and reasoning behind conclusions. As Stone, Patton, and Heen (1999) assert “At heart, blame is about judging and contribution is about understanding” (p.59). Stone, Patton, and Heen (1999) explain that a challenging point when interacting with others is when a conversation can threat our identity – “the story we tell ourselves about our selves” (p.112). Competence or to be competent is a core identity that can be threaten when interacting with other people. The all-or-nothing thinking can knock off balance. All-or-nothing thinking such as “I’m either competent or incompetent” makes us unstable and makes us hypersensitive to feedback. This all-or nothing mindset leads us to deny negative feedback or exaggerate and let the negative feedback define our identity. The fact is that we are humans, complex individuals, not perfect, and our intentions are complex too. In order to move away from all-or-nothing identity we need to understand that we are complex and accept that sometimes we will make mistakes, and if we do not acknowledge and recognize our mistakes and learn from them we will make the same mistakes again. Another crucial step to move away from all-or-nothing thinking is to acknowledge that sometimes we all have contributed to the problem at hand. At the end of
  4. 4. the day, moving away from all-or-nothing thinking will lead us to building trust because we will learn to feel comfortable being open to one another around our mistakes, failures, and weaknesses. As Lencioni (2005) affirms “People who are not afraid to admit the truth about themselves are not going to engage in the kind of political behaviors that wastes everyone’s time and energy” (p.14). And as Stone, Patton, and Heen (1999) affirm “The more easy you can admit to your own mistakes, your own mixed intentions, and your contribution to the problem, the more balance you will be during the (difficult) conversation, and the higher the chances it will go well” (p.119). Team members need to change a blame-game mindset for a contributory system way of thinking to look forward to problem solving. Another way to share views without raising defensiveness among others is to share thinking and feelings as “I” statements, expressing the impact that some objective and observable behavior or actions had on you, instead of attributing bad intentions to others behaviors or words. When working with teams, people need to be aware of the word choices because words can trigger emotions and hostile environments preventing us to reach understanding of the reasoning of some expressions. As part of the communication piece during training, team members need to be aware of the differences between dialogue and debate, while dialogue seeks understanding of each other ideas, debate listen with the purpose to refute what has been said. Being conscious about the words we use in specific settings, having clear purpose and generating some common language to revisit the team’s interaction can create the conditions needed to improve performance and reach effectiveness. A common language not only describe but also construct and shape our reality as we select words to describe it. As Lingard and et all (2002) affirm “This directs attention to the role of language in socialization and identity formation. Words act on us; they both make possible and constrain our understanding of our lives” (p.729). In this sense, we can affirm that the use of common language can be use to reframe the way healthcare professionals deal with conflicting situations and create a new organizational culture in healthcare settings. An Emotions Framework Gedney Baggs and Schmith (1997) argue that in order to get nurses and medical resident physicians working together there are two preconditions: Being available (in the right place, having time and having appropriate knowledge) and being receptive to the idea of collaborating which translates into engaging in discussion with active listening, openness, questioning; respect and trust. When Fisher, Ury and Patton (1991) explained the relationship element of interest-based negotiation model, they remark that “To find your way through the jungle of people problems, it is useful to think in terms of three basic categories: perception, emotion, and communication.” (p.22). When Fisher and Brown (1988) assert their framework for positive working relationships and its principle ‘balance emotions with reason’, they affirm “to varying degrees, emotions affect all our relationships. They affect how we think and how we behave”. (p.43). Fisher and Shapiro (2005) go further and developed a framework to help negotiators deal effectively with emotions. The authors focus on five core concerns that are important to most of the people: appreciation, autonomy, affiliation, status, and role. This “core concerns framework” can be use to stimulate
  5. 5. positive emotions that facilitates collaboration (cooperative behavior). Appreciation is related to having our thoughts, feelings, and actions devalued or acknowledge as having merits. Status is about our standing treated as inferior to others or given recognition when deserved. Finally role refers to the roles we play being meaningless or personally fulfilling. Considering healthcare professionals and their view about respect, knowledge and trust as preconditions for working together, training in negotiation, conflict management and team effectiveness should include a segment of this core concerns framework. Healthcare professionals could build affiliation with some shared values such us working toward the well-being of the patients. For instance, considering the Status core concern, there is a “social status” and “particular status” - understood as high standing in terms of particular expertise, experience or education. There might be cases in which a nurse should be consulted and appreciated by doctors and physicians. Doctors are regularly seen as with a “high-social status”, but nurses have several important areas of “particular status” in which they might outrank the doctors. Nurses acquire information that needs to be communicated. Sometimes doctors who hold high social status fail to listen to the nurses or to ask good questions. In any case, by appreciating the nurse perspective, doctors can build rapport, improve communication, and enhance patient treatment. As Fisher and Shapiro (2005) affirm “By acknowledging another’s (healthcare professional) negotiator’s particular status, you can shift their perception of themselves from that of an adversary pressing for a sale to that of a high-status expert working with you to help formulate a decision that will best meet interests on which are the experts” (p.110). A Teamwork Framework Once healthcare professionals have learned and have had a chance to practice these new frameworks and skills to deal with differences, and shifted paradigms about how they need to think to work together productively, they are ready to jump into teamwork and face the challenges innate to this dynamics. A framework that might help is the one developed by Fisher and Sharp (1998). We have reviewed some of the conditional elements for having effective working relationships, now we can place a framework for group collaboration and effective team work. Fisher and Sharp (1998) developed a framework to produce joint behavior that produces results. This approach highlights five basic elements to reach collaboration. “1. Purpose: Aim by formulating results to be achieved”, in order to achieve results team members needs to have a clear purpose of what they are trying to do and why they are doing it. Purposes should be realistic, actionable, and inspiring. If teammates have a chance to influence the purpose, they will work harder toward it. “2. Thinking: Harness the power of organized thought”, an organized way of thinking together and structuring discussion can help to generate ideas and turn them into action plans. The authors suggest dividing the process of thinking into four quadrants and explain the reasoning: a) Data: what is the problem? (Not who but what); b) Diagnosis: what are the possible causes of the situation? c) Direction: brainstorming about what strategies might be wise to do; d) Do Next: what are specific next steps? (Who does what when and where). “3. Learning: Integrate thinking with doing”, this means that team members need to implement and test their ideas by experimenting in the real world. Teammates need to plan, act, and evaluate (preparation-action-review); in this sense, they will be able to integrate thinking with doing by planning, acting, and checking to see what worked well and what to do differently. This will help the team to adopt learning habits. “4. Engagement: Offer everyone a challenging role”, each
  6. 6. person needs to have an active and attractive role so one will want to play. The role should command respect from others and allow one use it demonstrating his/her abilities. We all have emotional interests in our jobs; if the role serves the team member’s interests the teammate will be committed and if team members have some measure of control over what they do they will be committed to the tasks. Team members need to assume that contributing ideas is everyone’s job and if teammates are invited to set purposes, it will signal respect and their thoughts will be validated. People will be committed to goals that they have helped set. It is important to have everyone taking part responsibly in negotiating and dividing the work, ask each team member to disclose information to reveal strengths and skills, list tasks and then distribute responsibilities, “task assignment are floor on responsibility, not a ceiling” (p.150). Asking for input does not mean delegation of authority or decision-making power, but “allowing workers to suggest in the light of well-chosen criteria allows them to feel they have chosen their own task”. (p.151). In general, setting purposes, thinking systematically, and learning from experience provides a framework for inviting everyone to offer ideas. “5. Feedback: Express appreciation and offer advice”, expressing appreciation motivates people, the need for appreciation is an emotional need, direct the appreciation to the team members as human being rather than the teammate’s actions. When offering advice make it a conversation and first understand what the teammate is trying to accomplish, ask the advice’s recipient what s/he thinks about her/his performance and offer direction or suggestions sharing specific data and reasoning. Giving and receiving feedback allows us to learn from mistakes. Teammates can share with each other what sort of feedback they find more useful. In sum, clarifying the purpose of what the team wants to accomplish; understanding how to manage the power of organized thinking; learning how to integrate thinking with doing; getting team members engaged; and, learning how to give feedback is a practical framework to reach team effectiveness. Even in the heat of the moment, healthcare professional can always stop, have an “inter- professional moment” as named by Dauer (2008), and make a decision on the way to proceed next. Team members will have their voice heard, their knowledge and experience validated, and the person in charge of the team will make a decision. In any case, when the stakes are high and a decision needs to be made in a timely manner, and the decision might be made, but to maintain a positive working relationship, the team will needs to reconvene to be able to debrief about what went well and what can be done differently next time and integrate it as a learning experience moment. Once team members go thought a training that includes several of the skills and lessons learned from this set of organizing frameworks, they will likely have shifted or questioned their own paradigms, and we can move away from finder pointing toward problem solving. We have addressed the Lencioni’s (2005) ‘five dysfunctions of a team’ from a conflict management perspective. This proposed training in conflict management and development of effective teams has intended to share the belief that cultural changes in healthcare settings from bottom-up are feasible. Through conflict management training and building effective teams, healthcare professionals can change the healthcare organizational culture to do better, improve working relationships and work together toward the patient welfare enhancement.
  7. 7. Reference Dauer, E. (2008). Class presentation May 1, at Lipscomb University. Fisher, R. , & Brown, S. (1988). Getting together: Building relationships as we negotiate.New York: Penguin Books. Fisher, R. , & Shapiro, D. (2005). Beyond Reason: Using emotions as you negotiate. New York: Pinguin Group. Fisher, R. , & Sharp, A. (1998). Getting it done: How to lead when you’re not in charge New York: HarperCollins Publishers. Fisher, R. , Ury, W. , & Patton, B. (1991). Getting to yes: Negotiating agreement without giving in. New York: Penguin Books. Gedney Baggs, J. & Schmith, M.H. (1997). Nurses’ and resident physicians’ perceptions of the process of collaboration in an MICU. NResearch in Nursing & healthcare, volume 20, 71-80 pp. Lencioni, P. (2005). Overcoming the five dysfunctions of a team: A field guide for leaders, managers and facilitators. San Francisco: Jossey-Bass. Lingard, L., Reznick, R., DeVito, I., & Espin, S. (2002). Forming professional identities on the health care team: Discursive construction of the ‘other’ in the operation room. Medical Education, volume 36, 728-734 pp. Stone, D. , Patton, B. , Heen, S. (1999). Difficult conversation: How to discuss what matters most. New York: Penguin Books.