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Negotiation – Conflict Resolution 1
Conflict ResolutionA Core Leadership Attribute Seminar on Negotiation
Created By:Gus M. Garmel, MD, FACEP, FAAEM
Clinical Professor, Department of SurgeryCo-Program Director, Stanford/Kaiser Emergency Medicine Residency
Stanford University, Palo Alto, California
Tenet Editor:Barbara Blok, MD, FACEP
Assistant Director, Denver Health Residency in Emergency MedicineUniversity of Colorado School of Medicine, Aurora, Colorado
Negotiation – Conflict Resolution 4
Course of Conflict
Stalemate
Communication Failures & Conflict
Escalation
Negotiation & Conflict Resolution
Time
Inte
nsi
ty
Negotiation – Conflict Resolution 5
Outline
• Definitions & Relevance• Types & Factors of Conflict• Conflict Resolution
– Keys & Principles– Barriers
• The Art of Communications• Process of Negotiation
Negotiation – Conflict Resolution 6
Conflict
• Any situation where incompatible activities, feelings, or intentions occur together.
• A competitive or opposing action of incompatibles; an antagonistic state of action (divergent ideas, interests, or persons).
• Mental struggle resulting from incompatible or opposing needs, drives, wishes, or external or internal demands.
DEFINITION
Negotiation – Conflict Resolution 7
Conflict Resolution
• A range of processes aimed at alleviating, eliminating, or resolving conflict or its sources.
• The methods and process of negotiation, arbitration, and institution building which promote the peaceful ending of social conflict and war.
DEFINITION
Negotiation – Conflict Resolution 8
Negotiation
• A dialogue intended to:
– Resolve disputes
– Agree upon course of action
– Bargain for advantages
– Satisfy various interests
DEFINITION
Negotiation – Conflict Resolution 9
RelevanceModel of the Clinical Practice of Emergency Medicine*
*Created through collaboration of ABEM, ACEP, CORD, EMRA, RRC-EM, and SAEM
COMMUNICATION AND INTERPERSONAL SKILLS ISSUESComplaint ManagementConflict ResolutionInterdepartmental and Medical Staff RelationsTeam BuildingTeaching
Negotiation – Conflict Resolution 10
Relevance- For Emergency Medicine
• Conflict is often outcomes-driven and not process-driven
• Physicians are typically goal-oriented– EPs want to win & desire control– EPs focus on immediate outcomes (want
things to happen now)• great for patients• challenging for administrators/consultants
Negotiation – Conflict Resolution 11
Relevance- For Emergency Medicine
• Salaries & Schedules• Positions & promotions• Patient care• Interpersonal interactions• Medical legal protection• Professional satisfaction • Career security
Negotiation – Conflict Resolution 12
Relevance- Example
An emergency RN will not perform a certain task you have requested because she doesn’t feel it is necessary. You are a good clinician, but you have a reputation in your ED as being “difficult.”
E G
Negotiation – Conflict Resolution 13
Relevance- Example
76 year old female who doesn’t feel well is brought to the ED by her adult son. Her entire work-up is negative, but the son wants her admitted, despite no medical nor social indication.
E G
Negotiation – Conflict Resolution 14
Relevance- Example
A consultant doesn’t think that he needs to see the patient you are calling about at 1 AM. You don’t know this individual, but you’ve heard he is not well-liked by your colleagues.
E G
Negotiation – Conflict Resolution 16
Why Do We Conflict?
• Personal differences
• Information deficiency
• Role incompatibility
• Environmental stress
Negotiation – Conflict Resolution 17
Types of Conflict
• Intrapersonal
• Interpersonal
• Intragroup
• Intergroup
Negotiation – Conflict Resolution 18
Types of Conflict- Intrapersonal conflict
• Conflict within• Example
– Conflict in dealing with a particular type of patient
Negotiation – Conflict Resolution 20
Types of Conflict- Intragroup conflict
• Conflict between individual group members
• Example– Your colleague always grabs the sickest
patients and major resuscitations
Negotiation – Conflict Resolution 21
Types of Conflict- Intergroup conflict
• Conflict between 2 groups of people
• Example– Who performs the ED thoracotomy in a
trauma resuscitation (EM vs. Surgery)
Negotiation – Conflict Resolution 22
Types of Conflict- Interpersonal conflict
• Conflict between 2 persons• Example
– Conflict with a patient’s family member or nurse
Negotiation – Conflict Resolution 23
Factors in Conflict
• Personal Attributes
• Gender
• Ethnicity/Culture
Negotiation – Conflict Resolution 25
Factors in Conflict- Personal Attributes
• Keirsey’s 4 Temperaments
Negotiation – Conflict Resolution 26
Factors in Conflict- Personal Attributes
• Keirsey’s 16 Categories
ARTISAN GUARDIAN IDEALIST RATIONAL
Promoter Supervisor Teacher Field marshal
Crafter Inspector Counselor Mastermind
Performer Provider Champion Inventor
Composer Protector Healer Architect
Negotiation – Conflict Resolution 31
Factors in Conflict- Ethnicity & Culture
• Language• Behavior nuances• Negotiation style• Passion• Tempo• Culture• Custom
Negotiation – Conflict Resolution 33
Conflict Resolution- The keys & principles
• Gain insight
• Truth always
• Seek wisdom
• Never criticize
• Offer assistance
Negotiation – Conflict Resolution 34
Conflict Resolution- The keys & principles
* Garmel GM. Conflict Resolution in EM. In Adams Emergency Medicine (Elsevier), 2008.
Negotiation – Conflict Resolution 35
Conflict Resolution- The keys & principles
* Garmel GM. Conflict Resolution in EM. In Adams Emergency Medicine (Elsevier), 2008. Adapted from Ahuja J, Marshall P. Conflict in the emergency department: Retreat in order to advance. Can J Emerg Med 2003;5:429-433.
Negotiation – Conflict Resolution 37
Conflict Resolution- Barriers
• Preformed judgments• Poor communication skills• Cultural/gender barriers• Lack of understanding of both sides• Not possessing the right skill set• Not understanding negotiable vs. non-
negotiable• Pride
Negotiation – Conflict Resolution 38
Conflict Resolution- Barriers
• Cynicism• Criticism• Comparing• Competing• Complaining• Contending
Negotiation – Conflict Resolution 39
Conflict Resolution- Pearls
• Plan ahead for all possible outcomes• Know related policies &procedures• Respect your primary responsibilities
& obligations• Seek to Gain consensus, not to prove a
point• Recognize that the truth lies
somewhere in the middle
Negotiation – Conflict Resolution 45
The Art of Communication
Effective Communication is essential for
Conflict Resolution
Negotiation – Conflict Resolution 46
The Art of Communication
• Avoid (Obvious) Pitfalls– I’m the attending!– Because I said so!– I’m right! (or, You’re wrong!)– My way is the only way!– You’re just a … nurse/tech/NP/internist!– You’re an XXXXX !
Negotiation – Conflict Resolution 47
The Art of Communication
Strive to find mutual understandings– I can see your point, but I don’t feel you are
considering mine.– Let’s discuss this a bit more from the patient’s
perspective.– I’ve always respected (appreciated) your…– It seems that we disagree, which is fine, but I’m
just not comfortable with…
Negotiation – Conflict Resolution 48
The Art of Communication- Effective vs. Ineffective
Effective• Smile• Eye contact• Avoiding emotion• Active listening• Concentration• Attention• Focused
Ineffective• Snarl• Arms across chest• Finger pointing• Pacing• Distracted• Inattention• Disengaged
Negotiation – Conflict Resolution 49
The Art of Communication
Negotiation is the art of letting them have your way.
- Daniel Vare
Negotiation – Conflict Resolution 50
The Art of Communication
Let us never negotiate out of fear - But let us never fear to negotiate.
- President John F. Kennedy
Negotiation – Conflict Resolution 51
Process of Negotiation- The definition revisited
• Negotiation is a dialogue intended to:– Resolve disputes
– Agree upon course of action
– Bargain for advantages
– Satisfy various interests
Negotiation – Conflict Resolution 52
Process of Negotiation- Objectives
• Mutually satisfactory structure• Executed agreement• Lasting and mutually beneficial
relationship• Comfort with process and outcome• Accounts for feelings
Negotiation – Conflict Resolution 54
Process of Negotiation- Outcomes
Win/Lose
Win/Win Lose/Win
Lose/Lose
I Win
I Lose
YouWin
YouLose
Negotiation – Conflict Resolution 55
Process of Negotiation- Steps to success
• Have a plan• Broad to narrow• Actively listen & learn• Take notes• Unbundle issues• Paraphrase don’t parrot
Negotiation – Conflict Resolution 56
Process of Negotiation- Timeline
• Initial - assess situation, gather information (from multiple sources), establish trust, build the relationship
• Middle - patience, gather facts, consider counteroffers, mutual concessions
• End - accept, get mediator, walk away, follow-up, be gracious and complementary
Negotiation – Conflict Resolution 59
Process of Negotiation- Principled negotiation
• An interest-based approach to negotiation focusing primarily on conflict management and conflict resolution.
• Uses an integrative approach to find a mutually shared outcome
Negotiation – Conflict Resolution 61
Process of Negotiation- BATNA?
• Best Alternative To a Negotiated Agreement (BATNA)
• What will happen if negotiations fail?– Your course of action– Their likely course of
action
Negotiation – Conflict Resolution 62
Process of Negotiation- BATNA
• Develop your BATNA and attempt to determine theirs
• Only reveal your BATNA if it is better than theirs
• Consider accepting terms when their proposal is better than your BATNA
• Reject terms when their proposal is worse than your BATNA
Negotiation – Conflict Resolution 63
Process of Negotiation - Barriers
• Emotions– Fear & Anger
• Difficult Questions
• Difficult Personalities
• Complex Situations
Negotiation – Conflict Resolution 64
Process of Negotiation - Barriers: Emotions
Fear is like fire. If controlled it will help you; if uncontrolled, it will rise up and destroy you. Men's actions depend to a great extent upon fear. We do things either because we enjoy doing them or because we are afraid not to do them.
- John F. Milburn
Negotiation – Conflict Resolution 65
Process of Negotiation - Barriers: Difficult Questions
• Defer
• Deflect
• Delay
• Decline
Negotiation – Conflict Resolution 66
Process of Negotiation - Barriers: Difficult Personalities
• Often unavoidable • May result in or escalate conflict• Individual may have a position of
authority• Strategies
– Don’t reciprocate/stay positive– Deal only with YOU– Take a “surprising” step
Negotiation – Conflict Resolution 68
Process of Negotiation - Barriers: Complex Situations
• Repeat over time• Multi-issue• Multi-party• Intangible factors• Intra-organizational• Tangible factors
Negotiation – Conflict Resolution 70
Process of Negotiation- Pearls
• Find (and point out) common ground• Understand your counterpart’s
perspective• Work to shape their decision• Allow the other side to “save face”• Get them to think it was their idea!
Negotiation – Conflict Resolution 71
Process of Negotiation- When You Need Help
• Seek assistance from a trusted colleague or supervisor
• Refer to hospital bylaws and policies• Contact Human Resources• Call in mediator (or arbitrator)• Walk away• Don’t bring it home
Negotiation – Conflict Resolution 73
Summary Points• Conflict is inevitable• Do your homework• Identify personal attributes• Avoid emotional investment• Listen carefully to what is said• Don’t burn bridges• Understand your BATNA (and theirs)• Practice principled negotiation
Negotiation – Conflict Resolution 74
Final Remark
Successful conflict resolution can be challenging because it has so many elements and possibilities, yet it undeniably plays a large role in an emergency physician’s daily and career activities.
Negotiation – Conflict Resolution 76
National Residency Leadership CurriculumSpecial Thanks!
Funded By:An American College of Emergency Physicians Chapter Grant
Endorsed By:American College of Emergency Physicians
Emergency Medicine Council of Residency DirectorsEmergency Medicine Resident’s Association
Society for Academic Emergency Medicine
Negotiation – Conflict Resolution 77
National Residency Leadership CurriculumSpecial Thanks!
Senior Editors:Stephen Wolf, MD, FACEP
Andrew French, MDMatthew Mendenhall, MD, MPH
Tenet Editors:Britney Anderson, MD
Barbara Blok, MD, FACEPJeffrey Druck, MD, FACEP
Maria Moreira, MDLee Shockley, MD, MBA, FACEP
Administrative Editor:Barbara Burgess
Negotiation – Conflict Resolution 78
National Residency Leadership CurriculumThank You!
For More Information Please Visit:www.DenverEM.org www.CoACEP.com
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