dealing with difficult behavior
TRANSCRIPT
Dealing with Difficult
Behavior
Mamta Gautam MD, MBA, FRCPC, CPDC, CCPE
Objectives
1. What is disruptive behavior?
2. Why does it occur?
3. How can we best manage it?
Disruptive Behaviors
• Incivility, acts of disregard, rudeness
• Personal and unprofessional verbal attacks
• Impertinent and inappropriate comments or in written form
• Sexual harassment of staff, peers, patients
• Intimidating, belittling, non-constructive criticism
• Requiring unnecessarily burdensome activities of staff, unrelated to work to be done
• Public criticism of colleagues, dept, hospital
Bullying
• a form of aggression, “the assertion of power
through aggression”
• incivility that is pervasive and ongoing; a
pattern of behaviour
• intended to intimidate, harm, offend, degrade
or humiliate a particular person or group of
people
2008 Crisis Prevention Institute Inc.
Occasional outbursts can be normal
responses to stress at home or at
work
This is not our focus.
Possible Causes
• Anger in Grief and Loss
• Stress and Burnout
• Substance Abuse
• Psychiatric Disorders – depression, anxiety,
manic episodes, obsessive-compulsive
behaviors
• Personality Disorders – antisocial,
narcissistic, histrionic
Anger is always a
Secondary Emotion.
Identify what is
underlying it.
Remember that we can appear quite
intimidating.
Anger in Grief
• Anger is normal part of the Grief Reaction
• Expect it.
• Do not personalize.
• Allow it.
• Help the person identify the loss, and grieve
it.
Ten Types of Personality Disorders
• Cluster A: Odd, Eccentric, socially awkward
• Paranoid
• Schizoid
• Schizotypal
• Cluster B: Dramatic, emotional
• Antisocial
• Histrionic
• Narcissistic
• Borderline
• Cluster C: Anxious, fearful
– Avoidant
– Dependant
– Obsessive Compulsive
Cluster B Personality Disorders
• 1-3% of adult males
• 0.5-1% adult females
• Some cultures encourage and reward such
characteristics.
• Seek out and promote this – high achievers,
charming, good for business
Common Characteristics
• Lack remorse or guilt
• Superficial charm
• Grandiose self-worth
• Impulsive, spontaneous
• Prone to boredom
• Manipulative, lying, splitting
• Highly functioning and successful
People with a Personality Disorder
don’t know they have one.
View their symptoms as strengths!
People with a Personality Disorder do not
behave consistently…
Or do they?
Three Main Features
1. Lack insight, accept no responsibility
2. Projection
3. Splitting
Our Usual Responses
Want to be nice, understanding, avoid conflicts, positive and hopeful
• Let behavior go - deny
• Look the other way - minimize
• Hope it stops - rationalize
• Avoid direct discussion
• Become frustrated
• Eventually, leads to confrontation
Self Awareness
• Identify past incidents when others were
angry.
• What is your usual response to anger?
• Understand your own anger before you
can deal with someone else’s anger.
Why is it difficult to address?
• Makes us uncomfortable
• People tend to avoid conflict
• Feel disloyal to colleague
• Feel won’t be believed or heard, have no
power
• Worry about burden of proof, liability
• Fear of reprisals
Why should we address it?
• Costs to the person
• Costs to their family
• Costs to the coworkers
• Costs to the organization
• Costs both emotional and financial
Key points
• You can only change your own behavior.
However, you can create conditions which
can encourage others to make different,
more effective behavioural choices.
• Lack of insight can contribute to poor
behavioural choices
• Feedback creates conditions for personal
reflection and change
At organizational level
• Ensure that your department has:
– Clearly articulated cultural values regarding
communication, respect, professionalism
– Zero tolerance policy for disruptive behavior
– RCPSC Policy on Harassment and Intimidation
– Consider visual signs and reminders
“What you permit, you promote.”
At individual level
• Intent: Positive, compassionate
• Timely: Intervene early
• Privacy: Set limits with the person directly, privately
• Address each incident specifically, with suggestions
for improvement. Focus on behaviors and facts,
not people and interpretations
• Focus on clear expectations for conduct
• Ask them to tell you so you know they heard it
• Expect and prepare to deal with their anger
Managing Your Own Anger
• Acknowledge it - Every feeling is OK; it’s how
we express it that is/not OK.
• Write out feelings - use the Four Letter
Technique.
• Pick the fights you want to fight.
• Relax, stay calm.
Consider in a Confrontation
• Before: If. Use Rule of Thirds.
If so, Why?
• During: Who, What, When, Where,
How?
• After Possible Outcomes?
Avoid CLM’s.
Conflict Management is easy,
until you get ANGRY.
“Anger is when the tongue works faster than the mind.”
The best way to take the
wind out of someone’s sails
is to
AGREE with them.
Managing Anger from Others
MY FOUR A’S:
1. Admit, agree
2. Acknowledge
3. Apologize
4. Act
Conflict Resolution
Four Key Steps:
1. Define your needs.
2. State your needs.
3. Listen to the other person state their needs.
4. Negotiate a compromise.
CONFLICT RESOLUTION
• Decide on your “Bottom Line”
• Be specific and direct. Use documented facts to support your views.
• Use I/Me Statements
• Broken Record. “Yes…and” bottom line
• Give constructive suggestions, not just complaints.
• Don’t get stuck on Solutions; focus on Needs.
• You do not deserve to be yelled at.
• Say:
“Stop. I do not like to be yelled at.”
“I will discuss this later / in private.
• If continues later, repeat as above.
The Bully
• enjoys hurting people and making them cry - not want a productive relationship.
• becomes a bully because others freeze at the thought of confronting them.
• will trivialize your concerns.
• needs to be called on their behavior:
“I beg your pardon...That sounds like an insult, did you mean it that way?”
• Name the behavior, tell them you do not like it, tell them to stop.
Setting Limits
• Acknowledge : “It’s clear that...”
• Commit Involvement : “I’ll help you sort it out”. This is optional.
• Describe: “Words like...When I get told that..”
• Effect: “..I get defensive...I shut down...I can’t hear what you’re telling me”.
• Specified/Preferred Scenario: “I want you to slow down and tell me what you want...”
• Consequence: Mutual, positive.“That way, we can work together to solve this...sort it out”.
Don’t give away the control over how
you are going to feel that day!