emergency department directors academy phase i fall 2019 ......conflict management skills...

Emergency Department Directors Academy Phase I Fall 2019 Conflict Management Skills DESCRIPTION Callousness, anger, frustration, and tantrums are commonplace in the stressful environment of the emergency department. Many of our customers are in crisis. Everyone – emergency caregivers, private practitioners, patients and administrators – has needs that must be met. Explore what causes “communication breakdown.” Participants will discuss the origin of common ED conflicts and successful methods to resolve them. OBJECTIVES

• Describe the common causes of conflict and the origins of stress in the ED environment. • Review ineffective individual responses to stress and conflict. • Define the necessary communication skills to effectively address conflict, such effective listening, eye contact, avoiding

emotion, etc. • Describe the “Theory of Yes” and the concept of focusing on issues, rather than positions. • Design orientation checklists and materials. • Define and give examples of physician orientation plans. • Conflict Management Skills

11/12/2019, 1:30 PM - 2:45 PM FACULTY: Robert W. Strauss, Jr., MD, FACEP BIOGRAPHY: Dr. Strauss practices clinically and administratively and is the Assistant Chair of Emergency Medicine at the Christ Hospital in Cincinnati, Ohio. He is TeamHealth’s Corporate Vice President of Program Development. Among his organized medicine leadership positions, he is a past chair of the “Residency Review Committee for Emergency Medicine (RRC-EM), a senior ABEM director, and the Course Director of ACEP’s ED Directors Academy. He is chief editor and contributor to Strauss and Mayer’s Emergency Department Management. Dr. Strauss has been honored with several ACEP awards, including the “James D. Mills Outstanding Contribution to EM” in 2015, “ACEP’s Outstanding Speaker Award,” “Hero of Emergency Medicine,” and “Outstanding Contribution to Education in Emergency Medicine.” DISCLOSURE: (+) No significant financial relationships to disclose

DEFUSING LAND MINES:MANAGING CONFLICT EFFECTIVELY

Robert W Strauss, MD, FACEP Emergency Department Directors Academy

ACEP, Dallas – Spring 2019

ModeSitting

%10

AV Aids 40Participating 80

Stereotypical presentations involve sitting and listening without

participation. Effective learning involves multiple sensory modes.

RETENTION OF INFORMATION

CONFLICT OFTENRESULTS FROM INEFFECTIVE

COMMUNICATION

IS MORE THAN JUST THE WORDS

MEHREBIAN ON PERSUASION

Verbal Content

Vocal Expression

Visual Cues

100%

MEHREBIAN ON PERSUASION

We tend to overemphasize the content,

to convince them with the words.

If they’re not getting it,

perhaps … you’re not delivering it

VERBAL INCONGRUENCE

Ø The words don’t match the tone, posture and / or general demeanor of speaker.

Ø Examples:Ø The upset widowerØ The angry parentØ “I only hadda cupla behrs.”

VERBAL INCONGRUENCE

A personal tale

CONFLICT RESOLUTIONRULE #1

Observe the Activity

Listen to the Tone

HEALTHY OR UNHEALTHY

Ø Clear beginning and end

Ø When it’s over, it’s over

Ø It’s important

Ø Intensive –always

Ø Unknownpending

Ø Sense of crisisØ Your total

attention now isexpected

Ø Potentialdanger

• Emotional exhaustion 50%• Depersonalization 78%• Interferes with family 83%

• Occasionally• Frequently

50%33%

Survey of BC-EM

“WITH AGING, WE ARE LESS ABLE TO COPE WITH PHYSIOLGIC STRESS . . .MANY CAN NO LONGER COPE WITH FULL TIME PRACTICE.”

DENNIS WHITEHEAD, M.D.

“EVIDENCE OF SUBSTANTIAL SUBSTANCE ABUSE AMONG EMERGENCY PHYSICIANS.”

JEFF MARGULIES, M.D. ACEP WELLNESS COMM.

ORGANIZATIONAL CLIMATE

Ø Unequal status andpay;

Ø Authoritarian system (Captain of the ship!)

Ø Limited resources;Ø Malpractice fears.

PROPERLY REORDER THE 4 CS

Ø CostØ ConvenienceØ CareØ Caring

CONVENIENCE

ØWhat we want: Attention now!Ø How long will you wait?Ø When people have a choice

about their emergency care,they will choose byconvenience. The most important satisfier is …

CARING

Ø It’s not the level of careby which we’re judged.

Ø We run out of time, get stressed and take shortcuts

“We’ve got to kiss ‘em when they come in,

kiss ‘em when they leave, and touch them

every twenty minutes.”

Marshall Segal

AN ENVIRONMENT OF STRESS?

Ø Dissatisfied patientsØ Poor communicationØ Uncontrolled work environmentØ Expectations v. RealityØ Chaos

WE RESPOND TO STRESS BY HABIT, PATTERNS OF BEHAVIOR LEARNED AS CHILDREN

When under stress,we revert to an individually consistent personality style

Conflict Resolution Rule #2

Abraham Maslow

What makes us human is the time between impulse and action.

MASTERING YOUR OWN MIND KATHERINE ELLISON

For most of us, the lag time between provocation, impulse and action is shorter than a heartbeat—just a quarter of a second between the trigger event and the response of the amygdala. In that fraction of a second, our emotions have time to swamp our judgment—and often do.

What is your personal cue?

What is your individual manifestation of stress?

Mistake behavior

Do we learn from our mistakes?

Do you?

LUCY: DO YOU THINK ANYBODY EVER REALLY CHANGES?

LINUS: I’VE CHANGED A LOT IN THE LAST YEAR.

LUCY: I MEAN FOR THE BETTER.

CHARLES M. SCHULZ

CONFLICT RESOLUTIONRULE #3

Mistakes Reinforce

Mistake Behavior

”It takes 18 months to two years to change a

behavior . . . And you’ve really got to want to.”

Harles Cone

CHANGING“STRESS TOLERANCE LEVEL” A PERSONAL TALE

FOUR STAGES OF LEARNING

2.

1. UnConscious InCompetence

Conscious InCompetence

3. Conscious

4. UnConscious

Competence

Competence

”You and I will more readily make a change when we believe it will

make things easier.”

CONFLICT RESOLUTIONRULE #4

CONFLICT RESOLUTIONRULE #5

You can’t control anyone,

except, maybe . . . . . yourself.

CONFLICT RESOLUTIONRULE #5A

The most difficult people

don’t realize that they are

the “trigger men.”

CONFLICT RESOLUTION RESOLVING CONFLICTS

RESPONDING TO EMOTIONWITHOUT EMOTION

While it is tempting to fight fire

with fire, hot interpersonal andtense conflicts can frequently be effectively managed with . . .

“TO MAKE ONESELF UNDERSTANDABLE TO PEOPLE, ONE MUST FIRST SPEAK TO THEIR EYES.”

NAPOLEON

THE WORST OFFENSES

Ø Loss of control: Screaming is a form of (and one step short of direct) violence.

Ø Public humiliation is the worst insult.

THE THEORY OF

“YES”

RESOLVING DIFFICULT SITUATIONS TECHNIQUES TO TAKE HOME

Ø SilenceØ Eye CommunicationØ Theory of “Yes”Ø Gordon Technique

GORDON TECHNIQUE

When . . . . . . . . . . . .

I feel . . . . . . . . . . . . .

Because . . . . . . . . .

ACKNOWLEDGE AND VALIDATE

Ø Blaming blamers à escalates

Ø Placating, the common response, does not lead toresolution

Ø Acknowledgement andvalidation is consistentlysuccessful as a first step inresolving discord

FOCUS ON INTERESTS, NOT POSITIONS.

GETTING TO YES

FISHER AND URY

RESOLVING DIFFICULT SITUATIONS TECHNIQUES TO TAKE HOME

Ø SilenceØ Eye CommunicationØ Theory of “Yes”Ø Gordon TechniqueØ Acknowledge and ValidateØ Focus on IssuesØ Giving Feedback

WHAT IS ACCEPTABLE?

If I inadvertently do something that really irritates you, I’d like you to let me know by:

WHAT IS ACCEPTABLE?

If I do something that really pleases you, I’d like

you to let me know by:

“THE SKILL TO DOCOMES FROM THEDOING.”

CICERO