1. Team Conflict Nancy Ghanayem, MD Professor of Pediatrics (Critical Care) Director, Cardiac Critical Care

2. Disclosures No financial disclosures I have engaged in conflict I have facilitated conflict I am not an expert in conflict, but I do have experience

3. Number of Quality and Patient Safety Publications by Year (Pub Med) Borrowed from M. Scanlon

4. Ancillary Staff -Respiratory -Laboratory -Blood Center -Pharmacy -Radiology -OR Staff -Transport -Therapists -Dietician -Imaging techs -Environmental services Denotes PNPs, PAs, trainees Patient and families Doc RN Anc.

5. The Group Mind Each of us has only part of the information or expertise to get the job done. Crucial to a team is the right mix of intelligence (“really smart people”) and emotional intelligence. D. Goleman, Working with Emotional Intelligence

6. Emotional Intelligence Emotional intelligence is the ability to monitor one's own and others’ emotions, to discriminate between different emotions and label them appropriately, and to use emotional information to guide thinking and behavior.  Self-Awareness  Self-Regulation  Motivation  Empathy  Social Competence

7. Team Intelligence Capacity of the individual members of a team to learn, teach, communicate, reason and think together, irrespective of hierarchical position, in service of shared goals. Team members must:  Have shared identity to articulate common goals  Be willing and able to share information  Understand one another’s roles  Must have trust and support one another Gordon, Beyond the Checklist

8. Adapted from Crew Resource Management Communication is central element in effective teamwork Establish common language, both terminology and meaning Establish interpersonal relationships Establish predictable behavior patterns Maintain attention to the overall situation, to task, to self and to fellow team members Manage the team

9. Conflict in healthcare arise from a clash of perceptions, goals and values in an area where people care about the outcome.

10. Physician Leaders -Surgery -Critical Care -Cardiology -Anesthesia -Neonatology (assume within group arrows) Patient and families Doc RN Anc. Nursing Leaders - Inpatient (ICU, acute care), OR Hospital Leaders -CEO, CNO, COO, CFO, CMO, CIO, CSO (assume within group arrows) Academic Leaders -Dean -Dept Chairs -Section Chiefs (assume within group arrows) Denotes PNPs, PAs, trainees Indirect Patient Care Stake Holders Ancillary Leaders

11. Opportunities inherent in conflict Early identification of problems Promotion of proactive responses to problems Provides understanding of issues Encouragement of a culture of mutual respect, open communication and problem solving Means of working toward potential resolution

12. Importance of conflict resolution… Conflict that is allowed to fester doesn’t resolve itself Combatants become more entrenched in positions Co-workers feel compelled to take sides Morale suffers Less innovation and talent may leave Patient/family outcomes and satisfaction suffer

13. Innovation Creativity Debate Serendipity Trial & Error ‘Simple’ The Stacey Matrix: Challenge of Complexity

14. Assertive Unassertive Uncooperative Cooperative Avoiding (Lose/Lose) Competing (Win/Lose) Accommodating (Lose/Win) Collaborating (Win/Win) Compromising (Low form of Win/Win) Conflict Resolution

15. Assertive Unassertive Uncooperative Cooperative Avoiding (Lose/Lose) Competing (Win/Lose) Accommodating (Lose/Win) Collaborating (Win/Win) Compromising (Low form of Win/Win) My Experience Giving feedback re: performance ‘conflict averse’ Carry out directives of others that placed me in vulnerable position Patient rescue Formation of CICU Complex patient decision making Formation of a CICU Patient placement

16. Conflict management process Schedule time alone to think Identify and own the emotions related to conflict Try to look at conflict from the other’s perspective Analyze the probable sources of conflict Assess the importance of issues to you, the other person and the organization Determine the probable outcomes of avoiding or addressing the conflict Decide upon and execute a specific course of action

17. Force functions for conflict management Patient-centered focus Regular multi-disciplinary, multi-specialty conferences Consistent handoffs with clearly delineated goals Pre-intervention plans especially in complex patients Develop trust – modeled by leaders * Each employed at CHW

18. Conflict Management Leadership Strength in negotiating & resolving disagreements Handle difficult people and tense situations with diplomacy and tact Spot potential conflict, bring disagreements into the open and help de-escalate Encourage debate and open discussion Orchestrate win-win solutions Goleman, Working With Emotional Intelligence

20. Stages of Team Development Adapted from: Team Building. “Developing a Productivity Team: Making Groups Work Work” Forming Storming Norming Performing Maturation

21. Forming Member Behaviors Excitement, optimism, suspicion, anxiety Comments directed at leader Direction and clarification sought Failure to listen resulting in nonsequitur statements Issues discussed superficially Leader Behaviors Hold regular meetings to establish goals and mission Clarify roles Encourage participation and questions by all Facilitate learning about one another’s expertise Share all relevant information Adapted from: Team Building. “Developing a Productivity Team: Making Groups Work Work”

22. Storming Member Behaviors Defensive, competitive Arguments among members Attempts made to gains solutions Subgroups and coalitions form Leader is tested/challenged Members judge and evaluate one another resulting in tasks being shot down Task avoidance Leader Behaviors Engage in joint problem solving Establish a norm in supporting the expression of different views Discuss and share decision- making process Provide resources needed for members to do their job Adapted from: Team Building. “Developing a Productivity Team: Making Groups Work Work”

23. Norming Member Behaviors Attempt to achieve harmony Begin to confide in one another Ground rules, group decision- making and team activities standardized Members can support one another and disagree with leader Confidence increases as energies directed at team goals Progress noticeable Leader Behaviors Talk openly about your own concerns/issues Have members manage high stake items Give and request feedback Assign challenging problems for consensus decisions Delegate as much as members capable of handling Adapted from: Team Building. “Developing a Productivity Team: Making Groups Work Work”

24. Performing Member Behaviors Roles clear and contributions distinctive Take initiative and accept one another’s initiatives Open discussions and acceptance of different modes of operation Challenge one another to creative problem solving Seek feedback from one another and leader to improve Close to team Leader Behaviors Jointly develop a vision and goals that are challenging Question assumptions and traditional ways of behaving Develop mechanisms of ongoing self-assessment Appreciate each member’s contribution Develop members to their fullest potential through assignments, feedback and training Adapted from: Team Building. “Developing a Productivity Team: Making Groups Work Work”

26. Thank you