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Conflict management in the pharmacy: adequately preparing the pharmacy intern Jeffrey Copeland, Pharm.D. Regina Tabor, R.Ph. Nicole Farrell, Pharm.D. UIW.

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Presentation on theme: "Conflict management in the pharmacy: adequately preparing the pharmacy intern Jeffrey Copeland, Pharm.D. Regina Tabor, R.Ph. Nicole Farrell, Pharm.D. UIW."— Presentation transcript:

1 Conflict management in the pharmacy: adequately preparing the pharmacy intern Jeffrey Copeland, Pharm.D. Regina Tabor, R.Ph. Nicole Farrell, Pharm.D. UIW FSOP Oct. 3, with-personality-conflicts-at-work/

2 Disclaimer Dr. Copeland, Ms. Tabor and Dr. Farrell do not have a vested interest in or affiliation with any corporate organization offering financial support or grant monies for this continuing education program, or any affiliation with an organization whose philosophy could potentially bias the presentation

3 Learning Objectives At the completion of this program, the participant will be able to: 1. Explain the importance of preparing a pharmacy intern for conflict management. 2. Assess your own conflict management style using the “Conflict Management Tool”. 3. Identify ways to incorporate conflict management learning activities into an experiential rotation.

4 Conflict Management: Importance

5 Conflict Defined Interpersonal conflict: whenever two or more individuals interact and disagree Subject matter Intellectual Moral Emotional component Porter-O’Grady T. Embracing conflict: Building a Healthy Community. Health Care Management Review. 2004;29(3): Article Berger BA. Conflict Management. In: Communication Skills for Pharmacists. 2 nd edition. Washington, D.C. American Pharmacists Association

6 Why does conflict arise? Differences in: Values, personal attributes, perspectives, biases, roles, goals Miscommunication Scarcity of resources Dependence Porter-O’Grady T. Embracing conflict: Building a Healthy Community. Health Care Management Review. 2004;29(3): Article Berger BA. Conflict Management. In: Communication Skills for Pharmacists. 2 nd edition. Washington, D.C. American Pharmacists Association Can you think of other reasons conflicts arise that you yourself may have witnessed or experienced?

7 Why are conflict management skills essential? Conflict is always in our midst Expansion of interprofessional collaborative practice Unresolved conflict leads to Spontaneous combustion Collateral damage Physical manifestations Toxic work environment High turnover rate Berger BA. Conflict Management. In: Communication Skills for Pharmacists. 2 nd edition. Washington, D.C. American Pharmacists Association

8 Thompson DC, Nuffer W, Brown K. Characteristics Valued by the Pharmacy Practice Community When Hiring a Recently Graduated Pharmacist. Am J Pharm Educ. 2012;76(9): Article 170.

9 What Holds Student Interns Back? Fear: Losing the relationship Being the object of anger Being hurtful Being perceived as bad Cloud H, Townsend J. The Talk Can Change Your Life. In: How to Have That Difficult Conversation You’ve Been Avoiding. Grand Rapids, MI: Zondervan; 2005: Berger BA. Conflict Management. In: Communication Skills for Pharmacists. 2 nd edition. Washington, D.C. American Pharmacists Association

10 Your Conflict Management Style Using the pharmacy conflict management scale

11 The Conflict Management Scale Who: Zubin Austin, PhD and colleagues at the University of Toronto school of pharmacy What: Developed and established the validity and reliability of a conflict management scale specific to pharmacy practice and education 19-item inventory Goal: Promote self-reflection & self-awareness regarding individuals’ conflict management styles Austin Z, Gregory PA, Martin C. A Conflict Management Scale for Pharmacy. Am J Pharm Educ. 2009;73(7): Article 122.

12 Direct Pragmatic Indirect Principled Austin Z, Gregory PA, Martin C. A Conflict Management Scale for Pharmacy. Am J Pharm Educ. 2009;73(7): Article 122.

13 Conflict Management Style Imposing Settling Thwarting Avoiding Direct Pragmatic Indirect Principled Austin Z, Gregory PA, Martin C. A Conflict Management Scale for Pharmacy. Am J Pharm Educ. 2009;73(7): Article 122.

14 Your Turn Complete: The Conflict Management Scale (CMS) Four questions on the back of the CMS Record: Dominant style: letter circled most frequently Secondary style: next most frequently circled letter Austin Z, Gregory PA, Martin C. A Conflict Management Scale for Pharmacy. Am J Pharm Educ. 2009;73(7): Article 122.

15 Discussion: Four Questions In your day-to-day experience, what are some of the most common reasons for conflict with other people? What strategies do you find effective in identifying whether a conflict is serious or not? What tactics do you use to prevent a conflict from escalating further? What tactics do you use to resolve a conflict? If someone were involved in a conflict with you, what tactics would be most effective to use to “win you over”? What tactics would be less effective? Austin Z, Gregory PA, Martin C. A Conflict Management Scale for Pharmacy. Am J Pharm Educ. 2009;73(7): Article 122.

16 Conflict Management Training the Student Intern

17 UIW Curriculum: Conflict Management Pharmacy Communications P1 year Fall (2 credits) Conflict Management: Barriers I Lab: “assertive, aggressive, passive pharmacist” Barriers II Lab: “angry patient lab”

18 UIW Curriculum: Barriers I Lab Assertive communication: Stay calm Use of “I statements” (“I need”, “I feel”, “I deserve”). Example “Ms. X I would like to help you, but I need foul language to be avoided. We each deserve respect.” Example “Mr. Y I can see you are frustrated, but I need a calm explanation as to what went wrong. Why don’t we step over to the private consultation window and discuss things further.” Berger BA. Assertiveness. In: Communication Skills for Pharmacists. 2 nd edition. Washington, D.C. American Pharmacists Association

19 UIW Curriculum: Barriers I Lab Assertive communication: Broken record Example: “I cannot, in good conscience, fill this prescription as written.” (said repeatedly) Fogging Example: Prescriber: That is stupid! Why do I have to fill out a prior authorization for the medication? Pharmacist: I know this must be frustrating for you, but the insurance company will not cover the cost of the prescription otherwise. Berger BA. Assertiveness. In: Communication Skills for Pharmacists. 2 nd edition. Washington, D.C. American Pharmacists Association

20 UIW Curriculum: Barriers I Lab Assertive Communication: Sorting issues Example: Prescriber: I can’t understand why you would question my judgment on this prescription. I thought we were friends. Pharmacist: I am your friend, but I’m also a pharmacist. I need to discuss this issue with you as a pharmacist. As a pharmacist I feel that filling this prescription could cause Ms. Jones to have an allergic reaction. Berger BA. Assertiveness. In: Communication Skills for Pharmacists. 2 nd edition. Washington, D.C. American Pharmacists Association

21 UIW Curriculum: Barriers II Lab Step # 1: Active listening (repeat as needed) Appropriate eye contact Full attention to patient Do not immediately try to jump in and fix the problem When the patient is finished talking summarize what you have heard and ask any questions to further clarify their complaint (e.g. “ma’am or sir, please correct me if I am mistaken, but what I hear you saying is…”

22 UIW Curriculum: Barriers II Lab Step # 2: Skills used to address an emotional response/disarm the anger (allow the patient time to express their frustration and or concerns) Reflection: Ability to recognize someone’s emotional reactions and communicate your understanding of these reactions Example: “You seem frustrated by having had the long wait in the doctor’s office.” “I see that you are angry at me because you expected your medication to be ready” “I realize you have a serious health condition and it needs to be treated.” “I understand that your time is very valuable, and you seem angry that it is being taken for granted.” Legitimation: Express a sense of understandability of the patient’s emotion. Example: “I can certainly understand why you’d be upset. You came to me looking to find a filled prescription. I do not have the medication you are looking for. I might be upset also, if I were in your position.” Cohen-Cole SA. The "Difficult" Medical Patient. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; Chapter 228. Available from:

23 UIW Curriculum: Barriers II Lab Step # 3: Provide a reasonable straightforward explanation at this point of the problem: Example: “I do see that you are upset by the delay in getting your prescription and I also want to make it perfectly clear to you that I can understand why you’d be upset by the delay. Let me try to explain to you the situation and see if it makes sense. The shipment of the new drug did not come in last night to the pharmacy as expected. I have called to put a rush on the order, but I realize that it will not be in until tomorrow morning.” Cohen-Cole SA. The "Difficult" Medical Patient. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; Chapter 228. Available from:

24 UIW Curriculum: Barriers II Lab Step # 4: Problem-Solving with participation Identify the problem Clarify the nature/effects of the problem (be specific) Clarify your desire for change Stay on task Identify all possible solutions & decide which is best Cohen-Cole SA. The "Difficult" Medical Patient. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; Chapter 228. Available from: Berger BA. Assertiveness. In: Communication Skills for Pharmacists. 2 nd edition. Washington, D.C. American Pharmacists Association

25 Step # 4: Problem-Solving with participation Example: “After speaking with you about not having your medication in stock, I have two options to offer you. Please let me know which you would prefer. I do value you as a customer and would like to make things easier for you. If you would like we can call the pharmacy down the road and have them fill the prescription and have it ready for you to pick up or if you would rather we now have delivery service available in the pharmacy and I can have the prescription delivered to your house tomorrow morning. ” UIW Curriculum: Barriers II Lab Cohen-Cole SA. The "Difficult" Medical Patient. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; Chapter 228. Available from:

26 UIW Curriculum: Barriers II Lab Step # 6: Conclude the session Always end positively Example: “I am sorry you feel that way. Here is your prescription back. Please let me know if you would like me to assist you in any other way.” Step # 7: Step away and take some time to reflect on the situation Take a breather Quality/Assessment Follow-up: Cohen-Cole SA. The "Difficult" Medical Patient. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; Chapter 228. Available from: Berger BA. Assertiveness. In: Communication Skills for Pharmacists. 2 nd edition. Washington, D.C. American Pharmacists Association

27 Conflict Management: Techniques When to useSkillExample To avoid conflict escalationParaphrasing and restating“Dr. Z, you sound upset because I made this recommendation to discontinue your patient’s HCTZ.” When the other party has a piece of truth that needs to be acknowledged Partial agreement without self-indictment“You are right, there are some individuals with reduced renal function who still might benefit from HCTZ.” Anger that comes your way that is overly vague Ask for specifics“What is it about the recommendation that upsets you?” When the conflict is unfairly abusive and even Ownership of language and appropriately assertive tone of message “I am uncomfortable with your tone regarding this situation without understanding my reason for the recommendation.” If the conflict has heated up and emotions are escalating Contracting to talk at a later time“I need some time to think about what you said” McDonough RP, Bennett MS.. Improving Communication Skills of Pharmacy Students Through Effective Precepting. Am J Pharm Educ. 2006;70(3): Article 58.

28 Conflict Management: Preceptor Role Reinforce UIW Curriculum CMS Model Anecdotes Role play Coaching

29 Summary Importance of conflict management: Conflict is unavoidable, has negative consequences if put off & conflict management skills are a valued asset to a health care team Self reflection on using the Conflict Management Scale (CMS) allows an individual to better understand how they address conflict Instruction in conflict management is an important role a preceptor takes on in training a student intern: Examples: Modeling, role play, coaching, reiteration of UIW curricular teachings, self- reflection using the CMS

30 QUESTIONS?


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