1. Dysfunctional Teams Instructor Name

2. Learning Objectives Describe types of conflict and various management approaches Use a basic framework to problem-solve Develop techniques to assist a difficult team member

3. Conflict No one likes it Adds to stress Can destroy team dynamics Can influence career goals Can influence personal life

4. Some Conflict is Good Leading cause of business failure among major corporations → Too much agreement among top management” Lack of tension → Complacency Essential, ubiquitous part of organizations

5. Reflection Reflect on a time when you had conflict w/ a person (or a team) that didn’t function well Describe it What was the problem? How did you handle it?

6. Types of Conflict Issues Decision-making Topic-oriented People Emotional Feeling of resentment Relationships

7. Conflict Management Approaches Forcing – Getting your way Avoiding – Ignore, don’t deal Compromising – Agreement quickly Accommodating – Don’t upset other person (taking advantage of you?) Collaborating – Solve the problem together

8. Example You are one of 2 residents on GI wards You both want a GI fellowship Your colleague is constantly interrupting you on rounds, contradicting you They are making you look bad Rounds lose focus, drag on, important issues lost Confused attending and interns

9. Example cont’d You are bitter and angry You tell everyone how awful he/ she behaves You refuse to give up your weekend off to help him/her You confront the resident, tell them to back off, YOU are killing me, and I can’t wait until this month is over. I hope I don’t have to work with you again!

10. What would have been a better solution? Should you have involved others in the solution? If so, who? Is timing an issue? Could this have been headed off before it escalated?

11. General Framework for Collaborative Problem-Solving Establish common goals Separate the people from the problem Avoid making conclusions or judgments Encourage 2-way discussion Objective criteria to measure outcome

12. Establish Common Goals Focus on what both parties share in common We both want a GI fellowship We both want to spend time with our families and have weekends off We both want what is best for the patient

13. Separate the People from the Problem Depersonalize the situation Make the issue the behavior not the person People get less defensive Easier to resolve conflict

14. XYZ Approach When you (behavior), then (consequences), and I feel (feeling)…

15. XYZ Approach Example 1: Interrupt me on rounds When you interrupt me on rounds, we both look bad to the attending and I feel like you are hurting our chances for fellowship.

16. XYZ Approach Example 2: Resident interrupts intern on rounds When you interrupt me on rounds, then I can’t communicate my plan and I feel like my learning is affected.

17. XYZ Approach Example 3: Intern ignoring nurses pages When you ignore the nurses pages, the patient suffers, and I feel like you are not taking your responsibilities seriously. Do you want to be a doctor?

18. XYZ Approach Example 3: Intern ignoring nurses pages When you ignore the nurses pages, then you aren’t accessible in an emergency, and I am concerned the patient may suffer. Better approach!!

19. Avoid Making Conclusions or Judgments Don’t say: You are lazy! You are wrong! You are mean!

20. Make It a 2-way Conversation Do say: Do you realize you are doing this? How were you taught to do this? You don’t seem engaged - Help me understand what’s going on. Is there a reason you are struggling? How can I help you? What have you tried already?

21. Continue until Understood Keep your opening statement brief The longer your opening, the more worked up you get, the more defensive the other person becomes, the longer it takes to find a resolution Ensure understanding Clarify, ask questions This is important for both of us

22. Objective Criteria to Measure Outcome How will you know if your conversation worked? How can we evaluate our plan? Keep track of a measure? Number of interruptions, hours on rounds Less tantrums Let’s try it, and in 2 days sit down and reassess

23. Be Nice Agree with something (if you can) Yes, it’s stressful worrying about fellowship. I remember getting annoyed with so many pages, especially when many weren’t important, but …

24. Be Nice Approach multiple problems incrementally Choose your battles Basic problem first We’ll work on more later (i.e., next problem) I want this to be a great month and I want to help you learn

25. Example Using your earlier example Working in pairs or a group How could you have handled your situation better?

26. General Framework for Collaborative Problem Solving Establish common goals Separate the people from the problem Avoid making conclusions or judgments Encourage 2-way discussion Continue until understood Objective criteria to measure outcome

27. The Difficult Learner There seems to always be at least one!!!

28. Difficult Learners? Dealing with a difficult learner is a teacher’s worst nightmare Human nature – Blame the learner Coping Strategy – Ignore the learner Difficulties are not always 1-sided Interpersonal skills involve 2-people

29. What to Do Become better acquainted w/ learner Understanding his/her perspective = possible solution.... sooner! Inform leaner, “I am committed to your learning.” Take the problem seriously – don’t ignore

30. Why Are Some Learners Difficult? List several reasons why you think some people struggle or are “difficult” learners

31. Reasons for Difficult Learners Stressed Sick Poor coping skills Frustrated with a lack of support Feel vulnerable Feel scared Family situation Drugs, alcohol Financial strain Tired May not know any better …

32. Categories Capacity Lack physical / mental capacity to cope Cognitively inadequate or unable Personality traits Motivation Distractions Outside work (domestic, financial) Appear disorganized, can’t make decisions, make mistakes

33. Specific Behaviors & Suggestions to Consider Slow Familiarize learner w/ time expectations Poor knowledge or skills References, suggestions, give extra time Fear of failure Provide expectations & feedback “Mistakes are expected” “Think out loud to help me better understand your reasoning”

34. Specific Behaviors &Suggestions to Consider Poor interactions, interpersonal skills Make sure he/she understands how others perceive his/her actions XYZ Approach works well here Unmotivated - Most difficult Provide clear expectations Change the behavior, not the personality Grade accurately

35. For the Biggest Problems Don’t be afraid to involve the clerkship or program directors We all have a vested interest Medicine is a profession Keep it that way

36. General Framework for Collaborative Problem Solving Establish common goals Separate the people from the problem Avoid making conclusions or judgments Encourage 2-way discussion Continue until understood Objective criteria to measure outcome

37. References Whetten D, Cameron K, Developing Management Skills, 7 th edition, Pearson Prentic Hill, 2007 BMJ Career Focus 2002;325:S43 Mahan,The Clinical Teaching Handbook, Ohio State University College of Medicine, 2007

38. Questions???