conflict management and negotiation skills

8/3/2019 Conflict Management and Negotiation Skills

1/37

Managing Conflict &

Negotiation Skills

Drs. Ramesh Mehay & Nick Price

Programme Directors (Bradford VTS)


2/37

Aims

1. the causal factors leading to conflict

2. systems and strategies that may prevent it

3. skills in managing conflict positively


3/37

Scenario

John is a 54 y old man you have been seeing for low

back pain and has been getting repeat sick notes from

you.

One day, on a home visit to someone else, you see him

working in his garden.

Youve asked him to come in.

Call him in.


4/37

What's all the Fuss?

"An exhausting consultation

between a doctor and a patient which

often triggers off some powerful emotions eitherin the doctor dealing with them, in the patient or both!


5/37

And it can affect the next consultation


6/37

AND


7/37

You might carry those feelings back home

stress, fear, anger, low morale, helplessness

The patient might feel and take them home too

and thats not fair nor good for either of you


8/37

Can you relate to any of this

Are you hooked?


9/37

So, What are we after?

A (patient) lose lose (doctor) aproach ?

A (patient) win lose (doctor) aproach ?

A (patient) lose win (doctor) aproach ?

A (patient) win win (doctor) aproach ?


10/37

The Session Plan from here

1. Causation

2. Strategies & Skills to Prevent It

3. Strategies & Skills to Halt Escalation4. Recovery strategies when things go really belly up


11/37

Causation

Individually: take the next 5 minutes to reflect on a

emotionally dysfunctional consultation and the factors

you think led to it

In trios, pool together your thoughts and discuss new

items (flip chart)

Team up with another trio and pool together your

thoughts and discuss new items (flipchart)


12/37

Buckets of Shit: Causation

patient doctor

Unidirectional Consultations

Failing to

ICE

illness vsdisease

Missing cues empathise

Personalities

Language

Egotism

Patient behaviour that annoys the doctorChristie & Hofmaster (1986)Pull Yourself Together report (2000), Mental Health Foundation)

Certain Medical Illnessses- Christie & Hofmaster (1986

ORGANISATION

Before the consultation:

accessibility

conflict with others (otherpatients, reception)

Doctor running late


13/37

Doesnt all this remind you of

JoHaris Window?

Unknown

Things the

patient knows

Things the

patient dont

know

Things I know

about the

patient

Things I dont

know about the

patient

Arena

Facade

Blind spot


14/37

In trios, think about.

1. Things you can do to prevent consultations from

going bad

2. How you can recognise things are going bad

3. What can you now do to try and stop things getting

worse

(15 minutes)


15/37

CONFLICT PREVENTION

REDUCING THE CHANCES OF

CONFLICT


16/37

The Calgary Cambridge model

You cant go wrong!

Look.


17/37

INITIATION

Read the patients notes

Acknowledge and apologise

for running late etc

you told me to come in

Any others?

Establish Rapportand attend to patients comfort

(physical, emotional)

Figure out their agenda

Neutralise YOUR feelings

Be aware ofyour own negative verbal/non verbal cues


18/37

GATHERING INFORMATION

1. Explore ICE properly

2. Figure out the ILLNESS vs disease

3. Really show EMPATHY4. Figure out the patients agenda, Identify your agenda,

and BLEND the two.(SHARED AGENDA SETTING)


19/37

EXPLANATION & PLANNING

AVOID PREMATURE REASSURANCE

PITCHING explanation

SHARED planning WITH the patient CHECK understanding and acceptability (seeking

agreement before moving on)


20/37

Paying attention to your language

Prefacing your remarks

Sounds like", "So,", "In other Words", "Youre saying"

Avoiding absolute words such as "always" and "never" Replacing "loaded" words with neutral words.

"wastes time""takes time to"

Using words/phrases that have positive connotations

"She always wastes time""You want to work more efficiently. Reflecting the emotional tone of the message as well

as the words

eg sound like you feel xxx because of yyyy


21/37

Responding to Cues

Verbal/Non-verbal

Suchman 1997: patients seldom verbalise their

emotions directly and spontaneously, but tend to offer

cues instead

Skills to Consider: Encouragement, Silence, Repetition

(echoing), Paraphrasing


22/37

Following the helical model

ie what I say influences what you say in a spiral fashion

(ie what you then say influences whay I say next)

reiteration and repetition

coming back around the spiral of communication at a

little different level each time are essential


23/37

RECOGNISING THE PATIENT

WHOS GOING OFF ON ONE


24/37

Read the patient continuously

Verbal (HEAR) tone, pitch, rate, content

I sense that you're not quite happy with the explanations

you've been given in the past. Is that right?'

Non-Verbal (SEE) facial expressions, posture,

agitation

'Am I right in thinking you're quite upset about your

daughter's illness?

Check how you are feeling


25/37

DE-ESCALATING CONFLICT

BRINGING A STOP TO

ESCALATION


26/37

Principles

Take a deep breath, stay calm. Neutralise YOUR feelings

Be aware of you own negative verbal/non verbal cues

Dont fight anger with anger, Dont be defensive

Look for the reason for the reaction, remember, its

often not personal

Recognise and accept the feelings as natural and

reasonable

Remember that the irrational component of anger may

have it origins from previous experiences and you may

need to explore this (with care)


27/37

Specific Communication Skills

Get down physically to the patients level

Feedback what you see or hear

Go back and revisit the patients framework+ other

contributory reasons for the anger (INFO GATHERING) Listen to the patients distress

Express empathy, concern and support

Apologise that they feel upset (and mean it!)

Reformulate the main problems for the patient (INFOGATHERING)

Move on with the patient re: possible solutions, waysforward (JOINTLY) = PLANNING

Offer realistic and achievable help (PLANNING)


28/37

Try it again

John is a 54 y old man you have been seeing for low

back pain and has been getting repeat sick notes from

you.

One day, on a home visit to someone else, you see him

working in his garden.

Youve asked him to come in.

Call him in.


29/37

Confrontation with a little C

Sometimes, a little bit of confrontation can be good

eg challenging an attitude, belief or behaviour, to bring

something to someones attention, an uncomfortable truth

Your aims in this case would be to

Allow the pt to hear and acknowledge you without

destroying to Dr-Pt relationship

To address behaviour whilst affirming the patients worthas a person

BUT: our own anxiety gets in the way: our past

experiences of confrontation (personal and professional)

and the present situation lead us to either to sledgehammer

or pussyfoot or avoid


30/37

How DO You Do IT Then?

Be honest, be supportive

Feedback what you have seen or heard

directly from the patientits hard to arguewith the evidence

BUT

Do this sympathetically. Heron shows

you how..


31/37

Heron (1975) says

Signpost your intent

State what the problem is & the effect it has

effect on U and patient, use I statements

State what you would like to happen

and why (eg the benefits for both of you)

Make a valueing statement about the person

separate the pts behaviour from them as a person

Overtly demonstrate your care/empathy

Then give plenty of time, ask about feelings, explain

difficulty fo u too, negotiate how to move on (planning)


32/37

CONFLICT RESOLUTION

HOW TO RECOVER A

STITUATION THATS GONEREALLY BAD


33/37

Why recover? Let it go???

It is cost saving

Avoids polarization of parties

It is educative thru understanding

Probes wider issues

It promotes fairness

Gives disputants more control over the dispute process


34/37

Principles

You may need a cooling off period before engaging

Both parties (Dr and Pt) must be willing to participate

Establish ground rules

Ensure both you and patient understand win =win aim;

own volition into engaging, not enforced

No interrruptions whilst other is talking


35/37


36/37

How to Do IT

An agreement to talk about a set agenda

One party speaks without other interrupting

healthy venting of emotions, what the problem is for them

Other party paraphrases what they heard

First party corrects any miscommunication

Process repeats the other way round

What does each party need or want to happen..in light ofwhats been said

Boulle, L (2005) Mediation: Principles Processes Practice, Australia,

LexisNexis Butterworths


37/37

Key Message

if you resolve conflict positively you

can really build upon a foundation ofloyalty and trust in the relationship
http://images.google.co.uk/imgres?imgurl=http://www.homesdelascruces.com/assets/team-loyalty.jpg&imgrefurl=http://www.homesdelascruces.com/buyer/home-buying-tips.htm&h=200&w=300&sz=17&hl=en&start=7&um=1&tbnid=qBsYW-2P9oOoTM:&tbnh=77&tbnw=116&prev=/images?q=loyalty&svnum=10&um=1&hl=en

conflict management and negotiation skills

Documents