1. Athletic Training Management
Chapter 6
Managing Change, Conflict, and Burnout

2. Organizational Change
Change is the ONLY constant!
Either anticipate change and adapt or lose your competitive position.
The face of health care is changing and medical professionals need to adapt to the external changes forced upon them.
Missions may change to survive.

3. Organizational Change
Wellness programs, patient education programs, populations that are living longer, and the need for more long-term care and more community-based programs in mental health, chronic disease, and others have changed the landscape.
Change is not a barrier, but a problem to solve.
Once it is happening, it must be encouraged not dismissed.

4. Strategies for Change Rational-empirical
People are rational and will do what is in their best interest
Strength is founded in scientific method
Weakness is lack of time to implement and the fact people are seldom rational about change
Reactions to change vary from resistance, denial, fear, and sabotage, to belief and acceptance
An example of this data-based change and the corresponding fear is seen in clinics in the high school-outreach market.

5. Strategies for Change
With managed health care often dictating where patients are sent and with parents often choosing their family physician over the clinic supplying the athletic trainer, clinics do not make as much in referrals as they planned.
One response has been to leave the outreach market.
One fear has been lawsuits for failing to provide athletic training services where they have been.
The courts have never found athletic training services are required by law, but there is also the public relations perspective to consider.

6. Strategies for Change
Another set of tactics is called normative-reeducative strategies.
These presuppose people are motivated by unmet needs.
Changes need to be based on interpersonal communications to avoid lack of rationality.
Conflict resolution strategies, negotiations, and sensitivity training come into play as well.

7. Strategies for Change A third set is power-coercive.
I have the power and you will concede.
This is seen at all levels of government. If the party out of power wins office, all political appointees will be fired and replaced with the new party’s appointees. This is from the President’s cabinet to the city department heads.

8. Strategies for Change
The problem can be challenged, but at risk. The options are to resign if the change happens (and risk acceptance of the resignation) or to inform the media and hope public opinion holds the day.
Some politicians demand as a condition of employment an undated letter of resignation be given and then they can fill in the date at will.

9. Systematic Change
Veninga proposed four major steps to implement change.
First is awareness
Management must be open to change, the organization climate must be accepting to change, and management must have an interest in change.
It can only happen when employees perceive things are out of balance.
Second is diagnosis
Obtain objective data that can be used to cause change to being

10. Systematic Change The third step is intervention.
Collect information from various sources
Patient satisfaction surveys are a good form of this data in health care settings
Another example could be students getting an exit interview form to be completed at the end of their education program to assess their feelings about their preparation and their readiness for the job market
The third step is intervention.
What is changing must be clearly understood.
Resistance will be felt to any reductions in power or authority.

11. Systematic Change The fourth step is evaluation
Resistance can be lowered by having employees participate in the decision-making process.
Objective evidence of the success or failure of the change must be obtained and used for further modifications.
Acting because others are doing it is foolish, but failing to think that other’s problems cannot happen to you is equally foolish.
The fourth step is evaluation
History is replete with those who enthusiastically embrace change without any data to support its effectiveness
Two questions must be answered
Did the change resolve the problems?
Did the change result in any new problems?

12. Conflict Adjustment
Conflict can be defined as a competition where the parties to the conflict are aware of the directly opposite nature of their positions and in which each side holds its position.
Time and energy spent in improper competition (like turf wars) is time and energy not spent furthering the organization.
Conflict is not necessarily negative to growth.
Some think that growth cannot happen until conflict has been found, faced, and solved.

13. Conflict Adjustment Conflict is PERSONAL.
Anyone who says “Don’t take this personal, but…” is not being reasonable.
People engage in conflict specifically because they do take it personally.
Disruptive conflict can sabotage an organization.
People have a finite amount of energy to invest in work.
When in conflict people plot revenge and protect their turf.

14. Causes of Conflict Forsythe believes all conflict can be reduced to:
Competition for scarce resources
Use of threatening, antagonistic power strategies
Personal characteristics of group members
Competition invariably means when I succeed, you fail.
In contrast, cooperation leads to group success and decrease the potential for conflict.

15. Causes of Conflict
Among ways to exert influence some methods are more hostile than others.
Threats, punishment, and bullying are all contentious because they are direct, non-rational, and unilateral.
Such tactics increase hostility, counteractions, and unwillingness to compromise.
The ability to threaten sets up a new conflict and the use of threat increases that conflict.
Competitors enter conflict with the need to win while cooperators enter conflict with the need for everyone to get something positive out of it.

16. Causes of Conflict
Competitors often win because they do not care what is thought of them as long as they win.
Cooperators may withdraw rather than face the wrath of a competitor.
Depending on the setting one side may not even see their actions as aggressive.
Socially justified acts are not viewed as aggressive (defensive war).

17. Causes of Conflict Socially unjustified acts are aggressive.
World Trade Center and Pentagon bombings
Negative reciprocity allows one to do onto others to the extent it was done to them.
Invading Afghanistan to find Bin Laden and Al-Queda
Equity allows an “eye for an eye” but not more.

18. Roles Role definition reduces conflict Three types of roles:
Mandatory roles
What is basic to employment
Allowable roles
Not required, but what you choose to do
Disallowed roles
Actions that may not be done while employed
Practicing AT in a licensure state without a license is one

19. Roles Role description and role prescription must match
Role description is the actual job role
Role prescription is what you think the job role is
These two must be similar to succeed
Defensive employees are insecure and cause a lot of wasted time
Variety of causes including categorization, superiority, lack of communication
Defensive behaviors must be dealt with directly

20. Roles Defensiveness can be lessened in a number of ways
When employees fear evaluation, changing the process to one centered on problem solving with employee input often helps
When employees are getting messages of control or to impose solutions, changing to a problem oriented approach may help
When employees perceive management is neutral to their performance, empathy is a good rebuttal

21. Roles
Supervisors who show sensitivity for the feelings and worth of employees are perceived as sympathetic
Equality and provisionalism are the responses to counter superiority and certainty. These imply mutual planning is possible and the sender is researching possible alternatives and wants the receiver’s input.

22. Roles
Listening is a great response to defensive positions. Athletic trainers are listening outlets to athletes and patients a great deal of the time. By being a good listener the AT may begin to understand the threat.
Control of your own defensive feelings when with defensive employees is important. Little good comes from having two defensive people go at each other.

23. Feedback There are three types of feedback given to workers: Positive
Reinforcing behavior
Negative
Negative opinion without constructive suggestions
Problem-centered
Attacks negative problems but offers constructive opportunities for resolution

24. Feedback Another example than the book’s
The problem: illness causes an athletic trainer to miss substantial amounts of work
Positive feedback: “It’s great to see you back.”
Negative feedback: “You’ve missed twenty-four days out of the past thirty working days. You’re fired!”
Problem-centered feedback: “It’s great to see you back. How can we help you get caught up and stay on task?”

25. Feedback Benefits Costs Increased respect Misunderstandings decrease
Open communication increases worker’s self-concept
Costs
Labor intensive
May need additional employees to properly implement

26. Resolving Conflicts
Follett believed conflict resolution could be simplified into three positions
Win-Lose
Domination – I win, you lose
Lose-Lose
Compromise – neither side is happy
Win-Win
Integration – both sides are happy

27. Resolving Conflicts Miller’s gradient theory Approach-approach
Two desirable alternatives – as one is neared the likelihood of getting the other decreases
Avoidance-avoidance
As you near an alternative you see problems and head to the other which also has problems – caught between a rock and a hard place
Approach-avoidance
Where a goal is both desirable and hostile – as the goal is reached the pain caused renders the achievement not viable

28. Resolving Conflicts Double approach-avoidance
Where two goals are mutually exclusive – desiring to work in college sports and also a forty-hour week means if you take the college job you’ll work hours a week but your rehab skills will be more general and less specialized and you will have less respect from rehab specialists and physical therapists while taking the clinic job means you do not have the experience in the recent past to get the college position should one come open later and you really miss the adrenalin rush of the college environment.

29. Coalitions When each side in a conflict lines up supporters
Coalitions usually work on the “cheapest winning solution” where no one group can control the solution
Example: four voting groups (6 votes, 5 votes, 1 vote, and 1 vote). The most desired coalition for the 6 vote group is with a 1 vote group. If the 5 vote group is in the coalition, then they learn from the inside the strengths and weaknesses of the 6 vote groups position and can counter them

30. Resolving Interpersonal Conflict
Common methods include:
Imposition – I win you lose
Withdrawal – response to imposition is to quit
Inaction – where one side ignores the problem and hopes that it will go away
Yielding – retracting demands rather than having a confrontation which may be lost later
Compromise – (lose-lose) finding a middle-ground position
Problem solving – agreeing on the problem and then on a solution

31. Negotiation
Process where competing sides give their view of the issues, their positions, and exchange proposals
There are three approaches to negotiation:
Soft negotiator – goal is achieving an agreement – soft on both people and problems
Hard negotiator – goal is to win – hard on both people and problems
Principled negotiator – goal is to reach a wise decision – soft on people, hard on problems

32. Third-party Intervention
When negotiations break down third-party intervention is needed
The person is outside the entanglements of positions of the competitors
They can let both sides “save face”
Their success is dependent on the power they have in relation to other parties to the dispute

33. Intergroup Conflict
Causes of intergroup conflict may begin with competition – when one side wins, the other loses
In a society that values winners over losers, these groups are now enemies
The “realistic conflict theory” maintains competition is for scarce resources
Things such as food, power, wealth, territory, energy, and respect

34. Intergroup Conflict Social grouping is another source of conflict
Because these are in short supply when one wins, the other loses
Everyone wants to be part of the group that possesses the desirable objects
Because control equals success, groups try to win and prevent other groups from reaching their goals
Social grouping is another source of conflict
Are you part of “us” or “them”?
The notion of being in two groups is enough to activate discrimination favoring “my group”

35. Intergroup Conflict Forsythe suggests a “social identity theory”
Three assumptions here:
First, because individuals are categorized, they can be identified as being IN “our group” or OUT of “our group”
Second, people try to maintain social standing
Third, a great deal of social identity comes from group identity
Having a group identity can be confusing for athletic trainers at times

36. Intergroup Conflict Mediation
Athletic trainers are not coaches (management) and they are not athletes (workers), yet they have common goals. They are closer to management, but need to be separate. They cannot be good listeners and facilitators if they have to inform management of everything they find out. Some things, however, by law they must report (athletes doing harm to others or themselves, breaking the law)
Mediation
A way to resolve conflict before it gets unrecoverable

37. Mediation One way is to have each group prepare 3 lists
A list describing the qualities of our group
A list describing the qualities of the other group
A list describing the qualities the other group sees in us
A third party compiles the lists and exchanges them, then the groups can resolve the disparities

38. Stress and Burnout Stress refers to the body’s response to a stimulus
Modern psychological concept came from Hans Selye in the 1930s
He defined stress as a nonspecific response of the body to any demand made upon it
He defined positive stress as eustress and negative stress as distress
Both kinds of stress result in a response

39. Stress Body responses to stress
Selye termed the physiological response to stress the General Adaptation Syndrome
Selye defined the response as having alarm (‘fight or flight’ - negative) and resistance (adaptation - positive) or exhaustion (terminally negative - fatal is possible)
Body responses to stress
Arousal (increased awareness) and anxiety (feelings of tension, apprehension, and worry)
Nervous and endocrine response includes changes in heart rate and blood pressure and/or respiration rate and secretion of epinephrine (which can remain elevated in the blood for days or even weeks)

40. Occupational Stress Stress experienced at work
Greenberg identified five factors
Factors intrinsic to the job
Quantitative overload is too much work, qualitative work is having a job that is too hard to do
Study by Russek and Zohman found that of 100 coronary patients, 25% had been working two jobs, 45% worked over 60 hours a week, and prolonged emotional stress was present in 91%
Effects include job-dissatisfaction, lower self-esteem, escapist activity, and low motivation

41. Occupational Stress Role within the organization
Vaughn found certain survival responses in adults who grew up in high stress environments and that these were brought into the workplace
These included tenacity, diminished self-worth, preoccupation, lost sense of normalcy, intensity, responsibility, fear of loss and abandonment and denial
Role within the organization
Three factors, role ambiguity, role conflict, role responsibilities
Role ambiguity exists when you do not know what is expected of you

42. Occupational Stress Career development
Role conflict is when you are caught between the demands of two different groups such as athletes and coaches
Role responsibilities refer to the obligations that come with the job
Responsibility for people is more stressful than responsibility for things
Career development
Job security
In college or professional settings until recently this has not been a major issue

43. Occupational Stress Job status
In the past few years some football coaches when they change jobs bring their own athletic trainer with them.
Since the professional and college markets are stagnant, a comparable head job will be difficult to come by
Job status
For many there is a glass ceiling
Head athletic trainers at the D1 level have few places to go
I know of one athletic director that is a former NCAA Division I head AT (now AD at an NCAA IAA university)
I know of NO women who are currently head football athletic trainers big time D1 football programs
3 women are at the assistant level in the NBA, none in AAA or major league baseball, 1 is an assistant in the NFL, none are in the NHL

44. Occupational Stress
In the US there is the women’s NBA and then nothing for women’s professional team sports.
There are women employed on the LPGA tour and the women’s tennis tours
There are professional sports teams employing women in Europe but with another set of frustrations as male coaches and male team physicians will often conspire behind the athletic trainer’s back
In clinics there may be either a cooperative or a superiority-conscious supervisor depending on the individual and the state practice act for various professions employed there

45. Occupational Stress
Positive relationships refer to having coworkers who are supportive and understanding of what is expected
Good working conditions are a major variable to individual health and well-being
At its worst, the workplace can be a place you dread going to, with coworkers who sabotage your every move
Organizational structure and climate refers to your ability to participate in the decision making that controls your job role

46. Occupational Stress
When there is participation, employees feel greater job satisfaction and self-esteem
When there is no participation, all manner of escapist behavior is seen
An individual’s personal characteristics play a role
Internal characteristics such as anxiety levels, neuroticism, tolerance, and ambiguity
External characteristics include family problems, life crises, financial situations, and environmental factors
These stresses are not uniformly weighted
Different settings have different levels of stressors

47. Occupational Stress
For example, college athletic trainers are rarely home during the season and often miss family or children’s important milestones while clinic athletic trainers may have a limited role in the organization

48. Burnout A syndrome of physical and emotional exhaustion
This term coined by Freudenberger in 1974
Maslach defined burnout as a syndrome encompassing emotional exhaustion, depersonalization, and reduced personal accomplishment that can happen to people involved in caring for other people

49. Burnout In allied health professions causes can include
Disillusionment (differences in what you are qualified for and allowed to do)
Helplessness (being faced with situations that defy solution)
Work setting (being the one in charge when everything is collapsing and others blame you)
Status (not compensated commensurate with training and ability)
Funding (not provided with adequate resources to do the job)

50. Burnout
People labeled workaholics or idealists who are overcommitted to the time pressures of the job are susceptible
Women who combine the job of mother and healthcare provider are susceptible
Children who grow up in high stress environments seek out high stress jobs and are then susceptible
Yuen determined that little or no research has been done on pressures causing burnout in students during field experiences during their degree programs

51. Burnout
Symptoms include fatigue, illnesses, migraines, ulcers, feelings of helplessness and resignation, irritability, sleeplessness, withdrawal, depression, high blood pressure, smoking, drinking, illicit drug use, distancing, high risk sexual behavior, paranoia, and inflexible thinking
When the emotional cost overwhelms an ATs ability to cope, burnout occurs
Too many athletes to serve, coaches expectations, chronic injuries healing slowly, conflicts with administrators, coaches, or athletes all contribute

52. Burnout Five stages of burnout
Athletic trainers receive few rewards, experience role conflict, lack autonomy, and feel powerless to deal with their problems
ATs can be constantly in a high state of arousal and anxiety and therefore prone to burnout
Five stages of burnout
Job contentment – hey, you got the job and it is cool
Job disappointment – realization of what the job really is sets in – first symptoms may begin here

53. Burnout
Job disillusionment – add in overt anger and resentment – may attempt to distance yourself from your patients
Job despair – trapped by circumstances, finances, or other factors making escape impossible
Work redefined – change jobs, resign due to health problems, leave the profession – often those who change jobs will just repeat the cycle

54. Burnout Prevention Gieck offered the following:
Acknowledge you are stressed
Physical exercise helps relieve stress, withstand fatigue, and develop self-discipline and self-esteem
Diet goes hand in hand with fostering a healthy life-style by cutting down on sugar, alcohol, and caffeine
Acknowledge the workday has a definite end
The solution to being indispensable is to have interests outside of work

55. Burnout Extent of the problem
Time management may be the most important thing you can master
Other authors have suggested setting challenging but realistic goals, developing social support systems, taking vacations
Extent of the problem
Campbell, et al., study suggested 34.9 % of athletic trainers were symptom free
Remainder suffered some burnout
Those who considered themselves burned out were 7x more likely to consider changing jobs

56. Burnout
Susan Capel, a social scientist and burnout specialist, developed a questionnaire based on the Maslach burnout inventory and found no more burnout than other health care populations
She found 99% ATs had a lack of personal accomplishment, but that they had a high internal locus of control, 78% scored in the low range for depersonalization with 100% in the low or moderate area
She found 34% scored low for burnout, 66% moderate, and none high

57. Burnout
In assessing why people leave the profession she found only 21% leave due to stress
Although long hours were cited by 37% of respondents as a negative, only 4% of those who left the profession did so due to long hours
A far larger number left the profession to enter physical therapy programs or go back to graduate school