COMMUNICATION & BUY-IN · who is on which side. Disagreement is all about content. Most or all of the participants in the conflict, do not talk to each other. Feelings and assumptions

HOW TO DE-STRESS THEPOLITICS OF PHYSICIAN CODING

Howard Tepper Vice President for Physician Practices and Ambulatory Services, St. Joseph’s Healthcare System (SJHS)Regina Gurvich Chief Compliance Officer, Manhattan’s Physician Group

HCCA 2013, DC

COMMUNICATION & BUY-IN

PHYSICIAN BUY-IN

Physicians are in a unique position of trust

Determine what services are ordered and billed

PHYSICIAN BUY-IN

No Compliance Officer Biller Manager CEO

Lost their ability to bill MedicareOnly physicians have itOnly physicians lose it

WHAT WORKS WITH THE PHYSICIANS? You cannot do this alone

Must have senior clinical buy in

Pick the low hanging fruit first

Bring physician success stories with you

WHAT WORKS WITH THE PHYSICIANS? Less is more

The devil’s in the details Take home book Access to trainer or expert

Why is this important = how can this affect me? Focus training on physician’s unique role

WHAT WORKS WITH THE PHYSICIANS? Distinguish compliance from other administrative

hassles

Do not make compliance the bad guy

Correct coding and compliance does not equal decreased reimbursement

WHAT WORKS WITH THE PHYSICIANS? Its about getting credit for the work that is done

If you are not part of the solution You are part of the problem

Have ready and implementable solutions

Provide useful advice for private practice

WHAT WORKS WITH THE PHYSICIANS? Acknowledge their concerns

Do not get into a debate

Do not defend the rationale for the rules Help them comply!!!

WHAT WORKS WITH THE PHYSICIANS? These are not your rules

Purpose is to assist them

Compliance = Correct Coding = $ $ $

WHAT WORKS WITH THE PHYSICIANS? Schedule training around their schedules

Early Middle Late

Make location convenient

Serve food

WHAT WORKS

Don’t react

Don’t take it personally

Don’t be defensive

They are not yelling at you….

They are just yelling

COMMUNICATION AND DIVERSITY

“ Know the man before attempting to do him good." Nathaniel Hawthorne

“ Know the PATIENT before attempting to do him good."

NOT JUST LANGUAGE

If we all spoke English everything would be fine

50-90percent of communication is non verbal

COMMUNICATION STEPS

Listening, Explaining, Asking, Recommending Negotiating

PROCESS FOR CREATING MAJOR CHANGE

Establish sense of urgency

Create guiding coalition

Develop a vision and strategy

Communicate the vision

Adapted from “Why Transformation Efforts Fail” by John P. Kotter

PROCESS FOR CREATING MAJOR CHANGE

Empower broad-based action Generate short term wins Consolidate gains and produce more change Anchor new approaches in the culture

Adapted from “Why Transformation Efforts Fail” by John P. Kotter

WHAT ELSE ARE YOU UP AGAINST? “We’re not crooks” “We’re too busy” “Billing is not my job” “It’s not fair” “This too will pass” “Nobody ever told me that!”

MESSAGE POWER

This is important Why we think this is

important Why you think this is

important Why you think this is

important to people we care about

► Lower► Low

► Moderate

► Higher

PRE-COMMUNICATION

If you don't care where you're going

……It doesn't make a difference which path you take

Fix what's broken

Fix what's not broken

CONFLICT

TYPE OF CONFLICTS

Personal Professional Emotional Personality Litigation Political Geo-political Military….

“The ability to deal with people is aspurchasable a commodity as sugar or coffee,and I will pay more for that ability than forany other under the sun.”

JOHN D. ROCKEFELLER

WHAT IS “CONFLICT”? Organizational conflict is a state of discord

caused by the actual or perceived opposition ofneeds, values, and interests between peopleworking together.

Conflict of Interest can be defined as anysituation in which an individual or corporation(either private or governmental) is in a positionto exploit a professional or official capacity insome way for their personal or corporatebenefit.

WHAT IS “CONFLICT”? Interpersonal conflict occurs when two or

more individuals who must work together fail to share the same views, and have different interests or goals. Interpersonal conflict can be defined by the focus and source of the conflict.

TYPES OF CONFLICTS

People-Focused vs. Issue-Focused Personal Differences Informational Deficiencies Role Incompatibility Environmental Stress

CAUSES OF CONFLICT

Difference of style Poor communication Different value Differing interests Scarce resources/ budgets Personality clashes Poor performance

EFFECT OF CONFLICT

Mis-communication resulting from confusion Refusal to cooperate Quality problems Missed deadlines or delays Increased stress Decreased customer satisfaction Distrust Gossip

CONFLICT VS. DISAGREEMENT

People talk to each other about what they disagree about, and everyone knows who is on which side.

Disagreement is all about content.

Most or all of the participants in the conflict, do not talk to each other.

Feelings and assumptions are so strong that the parties cannot or will hear.

Conflict is all about form.

Disagreement Conflict

NEGATIVE EFFECTS OF ORGANIZATIONALCONFLICTS

Divert time and energy from the main issues Delay decisions Create deadlocks Drive unaggressive committee members to the sidelines Interfere with listening Obstruct exploration of more alternatives Decrease or destroy sensitivity Cause members to drop out or resign from positions/committees Arouse anger that disrupts a meeting Interfere with empathy Leave losers resentful Incline underdogs to sabotage Provoke personal abuse Cause defensiveness

CONFLICT REACTION PROFILENUMBERING SCALE: 1 – SELDOM; 2 – SOMETIMES – 3. MOST OFTHE TIME

1.___ I can be swayed to someone else’s point of view.2.___ I shut down people who I disagree with.3.___ I address the issue at hand diplomatically and do not attack the individual.4.___ I think that others try to ‘bully’ their way with me.5.___ I express my thoughts and beliefs tactfully when they differ from those just expressed.6.___ Rather than offer my opinion when I disagree with someone, I keep it to myself.7.___ I listen to other people’s point of view with an open mind.

CONFLICT REACTION PROFILENUMBERING SCALE: 1 – SELDOM; 2 – SOMETIMES – 3. MOST OFTHE TIME

8.___ I let my emotions get the best of me.9.___ I raise my voice to make my point.10.___ I tent to belittle other people when making my point.11.___ I look for ways to negotiate and compromise with others.12.___ I have been told I am too pushy.13.___ I make sure I have my opinion heard in any controversy.14.___ I think conflict in meetings is necessary.15.___ I am the most vocal in meetings when trying to get my point across.

CONFLICT REACTION PROFILE & YOURSCORE

Scoring:• Add the total score from questions 1, 2, 4, 6, 8,

9, 10, 12, 13, 14, 15• Subtract the sum of the score from questions 3,

5, 7, 11

Your Total: _______

*The Thomas Kilmann Instrument

CONFLICT REACTION PROFILE SCORE

1-4: “Pas ~ You may be such a pushover that you allow difficult

people to walk all over you. You will benefit from learning to stand up for your ideas and opinions in a diplomatic and tactful way.

5-10: “Asser~ You are professionally assertive when dealing with

people, particularly difficult people. Continue to be open to listening to different points of view, and express your ideas and opinions appropriately.

11+: “Aggressive” You may be so combative that people might avoid

interacting with you. You will benefit from learning to listen and express your opinions more effectively.

DEALING WITH CONFLICT – THOMAS/KILMANNMODEL

CONFLICT RESOLUTION STYLE

Approach Characteristics Examples of Appropriate Use

Avoiding You don’t want to deal with conflict so you stall or ignore issues.

- When one or more parties need time to clam down or consider a situation.- When issues are of low importance.

Accommodating

You forego your concerns, act selflessly, and simply obey orders.

-You are learning a new skill.- The issue is of low importance.

Compromising You split the difference with the other party toreach a quick agreement

-The decision is a temporary solution.- The issue is of moderate importance.

Competing You want to get your way no matter how it affects the other party.

- Securing a contract for new business- Ensuring compliance- When a quick decision is needed

Collaborating You are concerned with fully satisfying both sides. You work long and hard to find a solution.

- When integrating long term solutions.-When gaining commitment- Building bridges

CULTURE-BASED

Western cultural contexts: Fostering direct communication between

disputants

Non-Western cultural context: Involves third-party mediator

Intercultural context: Mixed approach

WAYS OF ADDRESSING CONFLICT

Accommodation – surrender one's own needs and wishes to accommodate the other party

Avoidance – avoid or postpone conflict by ignoring it, changing the subject, etc.

Collaboration – work together to find a mutually beneficial solution

Compromise – bring the problem into the open and have the third person present

Disputes will not be discussed & addressed

Misunderstandings are not resolved

.

THE RESULT:

People who disagree, are talking to each other,

People in conflict are not

STRATEGIES FOR REDUCINGCONFLICT

PROCESS CONFLICTS:“How much control do I have over this process conflict?”

Identify the root cause of the problem and analyze the improvement opportunity

Talk first to the owner of the process Describe the current problem and get

agreement Suggest a workable solution and action plan Follow-through on the plan and give

recognition to the owner of the process

ROLE CONFLICTS:“Exactly how do I perceive my role in relation to others involved in this issue?”

Take responsibility for clarifying your role with others involved.

Be prepared to change your perception of your role.

Show your willingness to be flexible in achieving your organization’s goals.

Stay positive. View any role change in terms of the opportunities it presents.

INTERPERSONAL CONFLICTS:“How much my personal biases and prejudices affect this relationship?”

Write down three behaviors that you could change in order to reduce the conflict in this relationship.

Commit to following through on these changes for at least three months.

Ask the other person involved how you could defuse the existing conflict. Encourage feedback that might seem brutally honest.

Put yourself in their position. How do you think they view your commitment to reducing conflict in your relationship? Why?

Make a list of 5 strengths that you see in the other person. Then list five ways that improving this relationship would benefit you.

DIRECTION CONFLICTS:“Am I clear on the direction or vision?”

Clarify the discrepancy so that it can be easily described in neutral words and take action.

Ask permission to address the discrepancy with the other person in a friendly, non-confrontational way and gain agreement.

Use “I” and “we” messages rather than “you” messages.

If there is a difference in values, always go with the higher value.

Make authentic commitments.

EXTERNAL CONFLICTS

“How much control do I have over this factor?”

Choose to fight battles that are worth the price. Put your energy into things you ‘can do’ rather

than complain about what you ‘can’t do.” Do something good for others. Maintain perspective and a sense of purpose. Talk to someone you trust.

DEFUSE CONFLICTDEFUSE CONFLICT

1. Get educated2. Adopt a Zero-Tolerance policy3. Show respect4. Seek to understand both sides of any conflict5. Be solution oriented6. Show willingness to negotiate7. Be willing to be wrong8. Allow people to be different9. Practice good communication skills10. Stay calm11. Ask a neutral third-party to mediate

HOW TO OVERCOME DEADLOCK

o Attack the problem, not the persono Focus on what can be done, not on what can't be

doneo Encourage different points of view and honest

dialogue o Express your feelings in a way that does not blame. o Accept ownership for your part of the problem o Listen to understand the other person's point of

view before giving your own o Show respect for the other person's point of view o Solve the problem while building the relationship

STAGES OF CONFLICT RESOLUTION

o Focus on the issueo Meet on neutral groundo Stick to the factso Listeno Work for a win-wino Follow through and follow upo Be ready

COMMUNICATION MODEL

POWER

Sender Receiver

MESSAGE

FEEDBACK

ENVIRONMENT

PRINCIPLES OF FEEDBACK

Information about past behavior, delivered in the present, which is intended to improve future work relationship.

PRINCIPLES OF FEEDBACK

o It allows us to build, maintain, or test our relationships

o It is the best source of information

o It is a “reality check” of our perceptions, reactions, observations, or intentions

o It allows the recipient to identify and reinforce his/her positive contributions and to identify and change behaviors that are not helpful

FEEDBACK PROCEDURE

THINK…………………….A.I.D.

A = Action Tell the person what s/he said/did

I = Impact Let the person know how it affected you or the work

D = Desired change in behavior Tell the person hows/he can improve the situation

MOCKCONFLICT RESOLUTION

WHO HAS NEVER EXPERIENCEDCONFLICT OF ANY KIND?

WHAT DOES NOT WORK?

WHAT HAS WORKED FOR ANY OFYOU?

BUILDING THE BRIDGES WITHPHYSICIANS

INTERACTING WITH PHYSICIANS

General characteristics - Usually competitive in nature

Like to be the best or a leader in their field Compete with their peers as well as themselves

High school to college College to medical school Medical school to residency and fellowship Residency and fellowship to private or academic practice

Like challenges Desire perfection Want to be correct


General characteristics

o Interested in processes thato Improve quality of patient careo Improve productivityo Improve patient satisfactiono Improve efficiencyo Improve reimbursement and cut cost


General characteristics Education

Highly educated in their field and/or specialty

Usually interested in advancing their understanding of the healthcare industry Specifically interested in understanding

outside factors that may impact them Personality

All walks of life but share common traits such as: Want to do the right thing Analytical thinkers Usually collaborative Research, science and fact based oriented Entrepreneurial


Capitalize on their general characteristics Competitive by nature

Provide data when discussing compliance concerns that compare them to their peers, locally, regionally, and nationally, if possible

Be mindful of their time Just the facts

Pointers – Building Bridges


Generally, don’t start off conversations with

In accordance with the law you must .... The OIG said…. CMS Billing Manual citation…. Penalties under the False Claim Act are….

Pitfalls – Instant Bridge Burners

BUILDING PHYSICIAN - COMPLIANCEOFFICE RELATIONSHIPS

Politics Get buy-in from the top

Learn the landscape and develop your Physician Champions

Implement a program with your Physician Champions that works for your organization

Remember these Physician Champions are your greatest advocates to facilitate delivery of your compliance message to the medical staff throughout your organization

Pointers


While these are great ways for Compliance Professionals to discuss compliance issues, physicians may be thinking Here we go again, non physicians telling me how to practice

medicine This person doesn’t care about the patient Great, more work for me to do because some clipboard-

carrying administrator or blue-suit behind a desk feels my job isn’t difficult enough already

Who are you in Compliance to tell me how to run my practice

Pitfalls – Instant Bridge Burners


Politics Developing physician champions

Who, what, where, when, why and how

Theory to implementation

UTILIZING AND LEVERAGINGRELATIONSHIPS WITH YOUR PHYSICIANCHAMPIONS

How can the Compliance Office help the Physician Champions? These Physician Champions will receive

questions from their peers so it is critical that they understand some basic high level compliance issues

Macro level – be their advisor Physician Champions will need assistance

from the Compliance Office


Politics do play a role You need buy-in from the top

CEO, CFO, COO These individuals have a significant, vested interest in

compliance. It is these individuals with whom you discuss increased efficiency, decreased risk of penalties, fines, and so forth

If these individuals are on board with the compliance program, it should make it easier to get physician buy-in and involvement

These individuals may be able to help encourage physician interaction with the Compliance Office


Buy-in is critical Have to understand your corporate culture to

select and develop your Physician Champions

Build something that works for your organization

Be sure to communicate and monitor the compliance message being delivered by your Physician Champions

Summary


What will the Physician Champions do once the relationship is developed?

They are eyes and ears among their physician colleagues Report on areas of concern from a physician’s point of

view They serve as advocates for the Compliance Office

They may be the ones to carry the “compliance torch” among their peers

Most importantly, they are your liaison between the medical staff and the Compliance Office and can be instrumental in advocating for change within an organization

Assist with breaking down the us vs. them mentality Encourage reporting of violations and suspected

violations Influence physician participation in educational

programs


Politics Buy-in can not come by compromising on ethics or

integrity Result in less than favorable participation from your

Physician Champions Devalue your program and set you up for failure

Failure to know your audience is a disaster waiting to happen

Not all models work for every organization

Monitor the compliance message your Physician Champions are communicating to the medical staff

Pitfalls

UTILIZING AND LEVERAGINGRELATIONSHIPS WITH YOUR PHYSICIANCHAMPIONS

Be the Physician Champions’ advisor on macro level issues Major changes or proposed major changes that will

impact their area or the entire organization

Be the Physician Champions’ consultant on micro level issues Know their specialty and issues that impact their area Be their consultant for complex compliance issues

Involve the Physician Champions in education as often as possible when conducting training sessions with their peers

Pointers

WHAT YOU NEED TO KNOW ORINTERACTING WITH PHYSICIANS


Know your audience Know their focus Know their compliance risk Know their characteristics


Know your audience What is their main focus?

Patient Care and patient safety What is their compliance risk?

Documentation problems Billing for services

Not Documented Poorly Documented

Up-coding and/or down-coding Risk management issues Incorrect reimbursement issues Increased cost to correct mistakes


Capitalize on their general characteristics Appeal to their interests

Demonstrate how documentation can Improve the quality of care and decrease safety

risks Improve overall productivity and efficiency Improve patient satisfaction Improve reimbursement and cut cost



Capitalize on their general characteristics Education

Provide examples relative to their specialty Provide data from their specialty organization Explain how this helps them to be in the top of their

profession and how compliance impacts their specialty Personality

Ask for their input on how to better improve compliance

Provide facts about what needs to be improved and why Explain why this is the right thing to do



Conversation starters Dr. X, the Compliance Office has identified an

opportunity you can use to Improve patient care and patient satisfaction Reduce risk to patient safety Ensure your documentation can be utilized more

efficiently by yourself and other practitioners Ensure your documentation reflects the excellent

care you provide to your patients

Pointers-Building Bridges


Appeal to their interests to improve patient care

Appeal to their competitive nature

Understand how to phrase and tailor your discussions and educational efforts with physicians so that each encounter is as effective and efficient as possible

Remember, the goal of most physicians is “the patient comes first” so try to work compliance into their daily patient care routine

Above all, most physicians want to do the right thing!!!!

Summary


Develop your Physician Champions Where to start?

Respected physicians you know may be sympathetic to the goals and objectives of the Compliance Office

Grass roots approach Which physicians are already involved in

compliance-related areas Risk management Quality measures Patient safety CMO and COS Accreditation and Joint Commission Physicians with prior experience of an OIG

investigation or a CIA Other

UTILIZING AND LEVERAGINGRELATIONSHIPS WITH YOURPHYSICIAN CHAMPIONS

UTILIZING AND LEVERAGING RELATIONSHIPSWITH YOUR PHYSICIAN CHAMPIONS

How can the Compliance Office help the Physician Champions?

Physician champions will need assistance from the Compliance Office Understand the Compliance Program Plan

Why we have one in place and how it impacts the daily lives of their physician colleagues

Conflict of interest Fraud and abuse laws (Anti-kickback, False

Claims, and Stark)


Physician Champions will need assistance from the Compliance Office Major changes within CMS (FI and Carrier change to

MAC, PSC to ZPIC, RACs and MICs) Understanding the acronyms, alone, may be overwhelming!!! Major proposals such as the elimination consultation codes

and how this will impact their organization and practice




Macro level – be their advisor Assist with annual compliance training

Helps with both clinical and non-clinical staff to see that the Compliance Office is utilizing physicians to assist and provide guidance with training

Micro level – be their consultant Individual physician audits

Utilize your Physician Champions to help explain audit findings Less intimidating for the audited physician Helps transform the audit into a collaborative approach to

address the findings, mitigate the risks, and improve patient care

Specialty compliance training Training is provided by someone in the specialty practice

Peer to peer training Provide real-world insightful examples and commentary

on why compliance is necessary within the specialty


Micro level – be their consultant Billing, coding, documentation and operational

issues The Physician Champions encounter the same issues all

physician’s encounter so they can provide assistance with resolving these issues as they arise

Leverage their “referral” behavior and training The Physician Champions can “refer” their peers to the

Compliance Office to assist with questions or concerns



Capitalize on how this approach can mold and shape your culture

Leverage this relationship to network, engage, and build relationships with other physicians

Utilize the Physician Champions to make the Compliance Office more approachable

Utilize the Physician Champions to break down barriers and silos

Pointers

Don’t overload or overwork your Physician Champions

Don’t leave them on their own without your support-they need it

Your Physician Champions expect you to be the compliance expert they can turn to for help Give them the same level of expertise and

perfection that you expect of them

Pitfalls


POINTERS AND PITFALLS IN GAININGPHYSICIAN BUY-IN TO A COMPLIANCEPROGRAM

Interacting with physicians The ability to understand their focus and avenues

to relate or communicate is critical. Building physician - compliance office

relationships This is critical for the success of your Physician

Champions program as well as for the overall success of your compliance program

Conclusions

POINTERS AND PITFALLS IN GAININGPHYSICIAN BUY-IN TO A COMPLIANCEPROGRAM

Utilizing and leveraging relationships developed with your Physician Champions Tie everything together you have learned from

interacting with physicians and building your Physician Champions program to help mold and shape your entire organizational approach to compliance.

Leverage these relationships to integrate compliance into their daily routine

Utilize these relationships to network and continue your “Compliance Grass Roots” movement

Conclusions

A FEW THOUGHTS ONCOMPLIANCE PROGRAM

TRUE OR FALSE

1. Compliance risk does not apply to your practice2. You are too small to be flagged for external audit3. Buying compliance program ‘off the shelf’ will suffice4. Skill sets of billers, coders, compliance, and audit are

interchangeable & replaceable5. 1995 and 1997 Guidelines are about fashion statement6. Incident to = Shared = Split Services7. NPP services do not require MD presence, as long as

NPP has current license8. Locum tenens = Reciprocal = Per Diem9. Self-disclosure and repayment increase compliance risk10. PATH rules do not apply to private practice

THE AUDIT PROCESS

“The process of audit should be relevant, objective, quantified, repeatable, and able to

effect appropriate change.”

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1837310/

COMPLIANCE PROGRAM ON A SHOE STRING

Compliance Confetti Does size matter? What must be there? How many policies is enough? How often does it need to be reviewed?

Organizational Chart Governance Job description(s) and reporting

Audit Documentation Records retention policy Standardization of the processes

INSOURCING VS. OUTSOURCING

Scope of outsourced function(s) CO, hotline, credentialing, vs. individual audits

Considerations Financial constraints Staffing vs. skill set available Space constraints or availability

Local vs. ‘Long-distance’ contractual relationships

Contracting ‘Know thy consultant’ or vendor selection process Contracting under ‘privilege’ Periodic ‘refreshing’ of auditors pool

TRAINING & EDUCATION

Staff vs. leadership education Formal vs. informal modes Cost-conscientious approach

Webinars Printed materials Periodic e-Newsletters

Investing in line staff education & skill set

Needs to be ongoing and practice focused!

SCREENING

Credentialing & re-credentialing Compliance program as condition of Medicare and

Medicaid enrollment (coming soon) Physicians, Staff, and vendors

Initial vs. periodic Exclusions Ramifications of failure

Patients Identity verification

Screening for COI, Stark & Anti-Kickback Processes, documentation

LEGAL COUNSEL: OVERSEER OR PEER

Tangled relationship When to involve Legal Counsel?

Trouble shooting Mandatory Reporting of Adverse Events Governance Quality of Care External reviews

Analyzing obligations and timeframes post-internal review

COMPLIANCE: FROM COST-CENTER TOREVENUE CENTER

Benchmark Assessment & Gap analysis Physician buy-in

Connecting the dots of revenue cycle & compliance Ongoing conversation

Risk Assessment Denial report data as vulnerability Documentation standards Patient satisfaction Approved RAC Review areas

MEASURING SUCCESS

How effective are you? Are you asking the right questions? Are you documenting these questions? Are you sought after subject matter expert within

organization? Do you step outside of your comfort zone?

Internal scorecard for Compliance Feedback from external audits (RACs, MICs, ZPICs,

et al.) Number/ amounts of re-payments Transparency as an organizational culture

CASE STUDY #1 You are a CO at large IPA, which recently implemented

EMR. As part of the annual compliance work plan you initiated documentation, coding, and billing review.

IPA retains consultant to help you perform this review on-site. The consultant is evaluating a random sample of 50 claims on a pre-bill (Prospective) basis. The consultant starts review and by day 2 requests a meeting with you. During the meeting, the consultant relates that based on review of the first 30 records, 100% of the records included an automatic script/ auto-text of the time for nurse visits indicating that the service was performed incident-to a physician. Also noted were evaluation and management codes of 99214 and 99215 only.

This project is not performed under attorney-client privilege

CASE STUDY #1: CONSIDERATIONS Where should you start? Since review is done on pre-billing basis, is

overpayment of concern? How was the sampling conducted? (one location/ MD

or IPA-wide) You know obligations to Medicare and Medicaid, but

how should you treat other payers and self-pay? How do you communicate these findings? What does your audit file need to contain? What other remedial actions should be initiated? What other follow-up audits need to be conducted, if

any?

Comments?

Questions?

Self-Disclosures?

CONTACTSHoward Tepper, Vice President, Physician Practice and Ambulatory Service at St. Joseph's Healthcare SystemPhone: 973.754.2008Email: [email protected]

Regina Gurvich, Chief Compliance Officer, Manhattan’s Physician GroupPhone: 201-539-2773Email: [email protected]

REFERENCES

“Workplace Conflict”, Boston University FSAO “Resolving Workplace Conflict”, University of

Colorado-Boulder http://www.dalecarnegie.com Thomas-Kilmann Conflict Mode Instrument

Documents

COMMUNICATION & BUY-IN · who is on which side. Disagreement is all about content. Most or all of the participants in the conflict, do not talk to each other. Feelings and assumptions