Leadership Series 2007, #2

1. Leadership Series 2007, #2 The University of KansasMedical Center3901 Rainbow BoulevardKansas City, KS February 2, 2007

2. Conflict and Negotiating:When the Table is Uneven Phyllis Beck Kritek, RN, PhD, FAAN Conflict Engagement Specialist Consultant, Trainer, Facilitator, Coach pbkritek@msn.com

3. “Education is not the filling of a bucket but the lighting of a fire”Yeats

4. The “Fire” of Conflict • Dictionary • War, battle, struggle, opposition • Difference, disagreement, discord, clash • Thesaurus • Divergence, argument, quarrel, contradiction • Dispute, fracas, controversy, skirmish, fight • Cultural connotations – the WEST • Adversarial, threatening, dangerous, harmful • “Bad” outcomes unless you “Win”

5. An Alternative viewpoint:Conflict Engagement Frontrunners • Congratulations! • Reframing the experience • Enhancing analysis skills • Assessing existing competencies • Expanding competencies • Creating cultural change • Optimizing gains and growth

6. Creating an experience of a different kind of fire … through reflection

7. Conflict in Context… • All organizations have some type of conflict management system: the question is what type of system • Managing conflict is not resolving it • All organizations reside in, reflect, often further, and certainly adapt to the norms of the larger culture • All organizations have cultures that shape their approach to conflict

8. The roots of health care conflictsBack & Arnold’s “Let Go” Advice(JAMA, Vol. 293, #11, 2005) • Avoiding or denying conflict • Acting in the heat of the moment • Assuming you know • The whole story • The other party’s viewpoint • Repeatedly trying to convince the other party of your viewpoint

9. Cont…. • Proceeding as if the issue can be settled rationally or with evidence • Denying personal reactions, e.g., rage • Using anger or sarcasm • Declaring the other party • Responsible for the fix • Ethically questionable

10. A prescription for enhancing pride and joy in our work

11. Enter the Uneven Table:(My Preferred Terrain) • Place where some parties are disadvantaged and some parties do not know and/or acknowledge this: justice and fairness unlikely • Specific challenges • Assumptions of entitlement • Assumptions of victimization • High risk of generation of “settlements” that are not settlements: continuing injustices

12. “You must be the change you wish to see in the world.”Mohandas Gandhi

14. Coming to terms…Negotiate • To confer with another so as to arrive at the settlement of some matter • To deal with some matter or affair that requires ability for it successful handling • To arrange for or bring about through conference, discussion, and compromise

15. Restated…. ….a creative decision-making process initiated to address conflict which involves inclusiveness, timing, sharing, active listening, rules, principles, fairness, reframing, creative option generation… And, often…. An uneven table

16. Rethinking old barriers to constructive work relationships

17. Responses • Manipulation as historical MO of choice • “Unfair and Insidious” • Deceit • Thomas-Kilmann options (www.cpp.com) • Smoothing over (Avoidance) • Keeping the peace (Accommodation) • Cutting a deal (Compromise) • Counterattack (Competition) AND • Creative resolution (Collaboration)

18. Power Differentials as Context • “Metaphors We Live By”: Lakoff and Johnson: central metaphor of war, argument, competition • Focused on dominance, on power “over” • Emerged from distinctive US style (USIP) • Forceful, explicit, legalistic, urgent, and results oriented • Viewed by others as power-based effort to persuade, sermonize, or browbeat to accede • Assumed a fair and even table where all parties were equal, normalized dominance dynamics, and sustained dominant culture

19. An Alternative Insight…Why Smart People Can Be So StupidR. J. Sternberg (2002) • Omniscience: thinking I know more than I do • Omnipotence: thinking power applies in all domains • Invulnerability: embracing an illusion of complete protection

20. Building new bridges of self-awareness

21. Gender: Another Context • Explicit and implicit differences – examples • A woman uses 20,000 words per day, while a man uses about 7,000 • A woman remembers fights that a man insists never happened • Shifting cultural norms and practices • Workplace • Leadership • Habits of dominance and victim-think

22. The search for a gender- balanced dialog

23. Who put her in charge, and what’s the “ol’ buddy” act about?

24. Generations: Another Context • Generations in the workplace: 4 distinct groups • Traditionalists: 1900-1945 • Boomers: 1946-1964 • Generation X: 1965-1980 • Generation Y; Millennials: 1981-2000 • Boomers are running the show, have for some time now and are reluctant to “let go” • Generation Xers are in line to take over, often with neither support nor mentors

25. A Potential Reframing… • Leadership’s developmental stages could create new relationships in the workforce • Erikson’s “Eight Stages” – Stages 7 and 8 • Adulthood: Generativity vs. Stagnation Basic Virtue of CARE • Old Age: Integrity vs. Despair Basic Virtue of WISDOM

26. Crafting a worthy legacy

27. “Beyond the clamor of clashing ideologies and the preening and jostling of sovereign tribes, a safer and more responsible world is waiting to be created.”Norman Cousins

28. Time for some heavy lifting… tim

29. “a safer and more responsible world…”in context A brief guided tour of today’s Health Care System Challenges

30. The Overriding Context: The Health Care System • It is a complex adaptive system, hence harder to understand, often seen as chaotic • It has widespread inequalities and imbalances of power • It includes a diverse cast of characters with widely divergent cultures and value systems • It lacks clarity on who should be at the table Rob Robson and Ginny Morrison

31. Layered with Conundrums • Fundamental Ethos: DO NO HARM • Historical patterns of litigation as a problem-solving device • Industrialization and corporatization • Polarity management of cost containment and quality (with imbalances) • High stakes mission: life and death issues

32. Balanced by Key Assets • Humanistic, value-based practice, • Based on common goals among providers, • Who are invested in quality and advocacy, • Grounded in an ethical discourse, and • Granted credibility by the public • To do work that is integral to human existence and well-being

34. We are, However,Moving Toward aPromising Tipping Point Embracing creative new conflict management options…the “other” ADR

35. Tipping Point Essentials • A few people with • Contagious ideas with stickiness, • Making conscious choices, • Knowing little causes can have big effects, • With an awareness of context, and • Certain that change can happen in a moment Malcolm Gladwell

36. Catalysts for change • IOM • Crossing the Quality Chasm • Who Will Keep the Public Healthy? • To Err is Human • Keeping Patients Safe • JCAHO – Emerging Standards • Crucial conversations, Silence Kills • Leapfrog, Commonwealth Fund, etc. • Magnet Hospital movement and analogs

37. Health Care’s Crucial Conversations(AACN and Vitalsmarts, 2005) • Broken rules • Mistakes • Lack of support • Incompetence • Poor teamwork • Disrespect • Micromanagement

38. Themes Emerge: Conflict, unresolved, leads to Patient harms Patient dissatisfaction Poor work environments Employee dissatisfaction and resignations Failures in leadership Wasted resources and poor cost containment etc,etc,etc…

40. Repetitive Solutions Are Recommended Communication Collaboration Courage etc,etc,etc…

41. Authentic collaboration and constructive communication have become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.Negotiation competency has become an essential skill.

42. Hope springs eternal…

43. A “Yes,but…” Time Out • “I do it all the time; I must be good at it…” • “I have to do it under impossible conditions so there is nothing I can do to improve it…” • “I have a list of people who need this more than I do…” • “I am real nice and it works…” • “I get what I want my way; why bother…” • “I know nothing will change anyway…”

44. Lessons from the next generation… Visuals help…

45. How we like To think We present ourselves