Finding Middle GroundFinding Middle Ground

Team Conflict and ProcessTeam Conflict and Process

Alzheimer Society of Manitoba Conference Alzheimer Society of Manitoba Conference

March 5, 2007March 5, 2007

Peter S. Silin, MSW, RSWPeter S. Silin, MSW, RSWDiamond Geriatrics, Inc.Diamond Geriatrics, Inc.©www.DiamondGeriatrics.comwww.DiamondGeriatrics.com

Lawsuits, Threats, Lawsuits, Threats, ExplosionsExplosions

andand

Amazing ThingsAmazing Things

The ProcessThe Process

Three parts to work with challenging familiesThree parts to work with challenging families

Level I: Effective initial assessmentsLevel I: Effective initial assessments Level II: Effective problem understandingLevel II: Effective problem understanding Level III: Effective respondingLevel III: Effective responding

One on OneOne on One MeetingsMeetings

The better and earlier prepared, the easier it The better and earlier prepared, the easier it will be.will be.

Prevention Prevention

AssessmentsAssessments

Good Ax = Problem Good Ax = Problem understandingunderstanding

“ “ Difficult Families:” Care Home StudyDifficult Families:” Care Home Study Good assessments giveGood assessments give

Problem understandingProblem understanding PredictabilityPredictability Prevention: Where to put time and attentionPrevention: Where to put time and attention Directions for problem solvingDirections for problem solving

Initial Assessments: Initial Assessments: ResidentResident

GeneralGeneral Social Histories and PsychosocialSocial Histories and Psychosocial C.A.V.E. Model : Care According to C.A.V.E. Model : Care According to

Values ExpressedValues Expressed

C.A.V.EC.A.V.E©©

Focuses primarily on “personhood” of the client or Focuses primarily on “personhood” of the client or service receiver. service receiver.

Focuses on the spirit, personality, what makes this Focuses on the spirit, personality, what makes this person who they are and unique. person who they are and unique.

Requires the person or people providing services Requires the person or people providing services to focus on the person as a person, not as a “set to focus on the person as a person, not as a “set of needs.” of needs.”

Not a needs based system. Not a needs based system. Does not deny that an individual has needs, nor Does not deny that an individual has needs, nor

that a needs based model can be used that a needs based model can be used concurrentlyconcurrently . .

C.A.V.EC.A.V.E© ©

Provision of service follows from understanding Provision of service follows from understanding who someone is who someone is

Asks: what is/has been important to you? How Asks: what is/has been important to you? How have you lived/do you want to live your life have you lived/do you want to live your life

What are the values that you have lived under, What are the values that you have lived under, and currently operate from?and currently operate from?

What are some of the hard decisions you have What are some of the hard decisions you have made? made?

It says to individual, families, caregivers, we It says to individual, families, caregivers, we want to help live life the way you want to live it.want to help live life the way you want to live it.

C.A.V.EC.A.V.E©©

Resident generated vs. resident centredResident generated vs. resident centred An “inside out” modelAn “inside out” model Establishes a value base of careEstablishes a value base of care

Initial Assessments: Initial Assessments: FamilyFamily

HistoryHistory Dynamics: The Family DanceDynamics: The Family Dance

Then they’ll assume you cha-chaThen they’ll assume you cha-cha

RelationshipsRelationships Between Caregiver and residentBetween Caregiver and resident Between Family CaregiversBetween Family Caregivers

Initial Assessments: Initial Assessments: Families IIFamilies II

Individual Family Members Individual Family Members EmotionalEmotional PersonalityPersonality Life StressorsLife Stressors Previous History—IndividualPrevious History—Individual Personal AgendasPersonal Agendas SupportsSupports Care MapsCare Maps

Assessing Us: Assessing Assessing Us: Assessing ValidityValidity

Flexibility Flexibility SelfSelf staff staff AdministratorAdministrator system boardsystem board

Rigid SystemsRigid Systems The meaning of noThe meaning of no Then everyone will want to do itThen everyone will want to do it

Assessing Us: Assessing Us: Assessing Assessing Validity IIValidity II

Egos taking precedence to careEgos taking precedence to care Personal histories and triggersPersonal histories and triggers The meaning of conflictThe meaning of conflict INAM: it’s not about meINAM: it’s not about me Emotional IntelligenceEmotional Intelligence::

Understand one’s own and others emotions, Understand one’s own and others emotions, express them; ability to understand and manage express them; ability to understand and manage relationships and emotional process in relationships. relationships and emotional process in relationships. Leads to ability to handle oneself and relationships.Leads to ability to handle oneself and relationships.

Understanding and Understanding and Assessing the ConcernAssessing the Concern

The Problem: The Problem: About the About the ConcernConcern

Levels of Difficulty/ Influence 1Levels of Difficulty/ Influence 1 Facility: Facility:

Staff ActionStaff Action The SystemThe System External systemsExternal systems

We can influenceWe can influence

The Problem: The Problem: About the About the ConcernConcern

Levels of Difficulty/ Influence 2Levels of Difficulty/ Influence 2 Relationship/ EmotionsRelationship/ Emotions

Facility interaction/relationship/team processFacility interaction/relationship/team process Grief, loss, guilt, fear, etcGrief, loss, guilt, fear, etc Family dynamicsFamily dynamics

Sometimes we can influenceSometimes we can influence

The Problem: The Problem: About the About the ConcernConcern

Levels of Difficulty/ Influence 3Levels of Difficulty/ Influence 3 ThemThem

Past injuries and historyPast injuries and history PersonalityPersonality

We cannot influenceWe cannot influence

The ResponseThe Response

Response AbilityResponse Ability

Organizational HealthOrganizational Health Climate: Fun and HumourClimate: Fun and Humour Staff relations and relationshipsStaff relations and relationships Staff validation and supportStaff validation and support Communication, information, feedback systemsCommunication, information, feedback systems

Preparations for strifePreparations for strife Policy and procedures for difficultiesPolicy and procedures for difficulties

Rounds/EducationRounds/Education Early identificationEarly identification Response planningResponse planning

Group and conflict resolution skillsGroup and conflict resolution skills

When we can influenceWhen we can influenceProvide What We CanProvide What We Can

Level 1Level 1 Provide informationProvide information Allow our systems to bend Allow our systems to bend Problem solvingProblem solvingLevel 2Level 2 EmpathyEmpathy Supportive or intensive counselling Supportive or intensive counselling Work on relationship/team buildingWork on relationship/team building

Follow-up and reviewFollow-up and review

When we can influenceWhen we can influence Using ResourcesUsing Resources

Peer support and Family councilsPeer support and Family councils WebsitesWebsites Books and articles Books and articles System consultants System consultants Outside Agencies and consultantsOutside Agencies and consultants

When We Don’t Have When We Don’t Have InfluenceInfluence

Level 3Level 3 Empathic ResponseEmpathic Response Find the grain of truthFind the grain of truth Acknowledge the mistakesAcknowledge the mistakes Ask where they can help usAsk where they can help us Systemic ResponseSystemic Response

Options/LimitsOptions/Limits Follow-upFollow-up Start earlyStart early

Specific TechniquesSpecific Techniques

Responding to personalitiesResponding to personalities Bullying: setting limitsBullying: setting limits Splitting: create a uniform team, support Splitting: create a uniform team, support

each othereach other Slow things down: breathing, delayed Slow things down: breathing, delayed

response response MirroringMirroring Meta comments/ Comment on processMeta comments/ Comment on process ““I” statementsI” statements

Meetings: Conditions for Meetings: Conditions for Positive OutcomePositive Outcome

No hallway meetingsNo hallway meetings Set up a time and placeSet up a time and place Decide on who should be thereDecide on who should be there Enough time and time limitEnough time and time limit Set it UpSet it Up

Why it is being heldWhy it is being held Tentative goalsTentative goals

Create Conditions for Positive Create Conditions for Positive Outcome: PreparationsOutcome: Preparations

Debrief your groupDebrief your group Reframe your viewsReframe your views Decide on roles task and processDecide on roles task and process Self awareness of your triggersSelf awareness of your triggers

Meeting ProcessMeeting Process Meetings: Set the Stage Meetings: Set the Stage

Define the issueDefine the issue Agree on goals or objectives Agree on goals or objectives Agree on process of meetingAgree on process of meeting Acknowledge the difficulties and emotions Acknowledge the difficulties and emotions

Discuss the issue Discuss the issue Review historyReview history Ask for their comment on thisAsk for their comment on this Make sure they feel understoodMake sure they feel understood

Look for solutionsLook for solutions Brainstorming, best possible, win-winBrainstorming, best possible, win-win

Discuss and define follow-upDiscuss and define follow-up

Post Meeting/ Planning Post Meeting/ Planning MeetingMeeting

Debrief/How did it goDebrief/How did it go Response plan Response plan

ConsistencyConsistency Team buy-in Team buy-in System wideSystem wide Provide resources and education Provide resources and education

PreventionPrevention

Review admission/assessment proceduresReview admission/assessment procedures Review team buildingReview team building Review team maintenanceReview team maintenance Review yourselfReview yourself

Conflict & Quality Conflict & Quality ImprovementImprovement

How do we use conflict to improve quality How do we use conflict to improve quality of care?of care?

Data collectionData collection Systemic changeSystemic change