It’s Complicated: Teams , Resources & Relationships

1. It’s Complicated: Teams, Resources & Relationships Thomas A Hazinski Faculty Development Workshop Larry Bridgesmith, J.D. Steve Joiner, D. Min

2. What is conflict? • An unavoidable aspect of group life • “Any situation in which people have incompatible interests, goals, principles or feelings.”

3. Stages of Conflict Destroy Hurt Compete Disagreement Problem

5. Senge’s Ladder of Inference Beliefs Conclusions Assumptions Actions Inferences Selected Data Data

6. Amygdala Hijacks Understanding Stimulus Result: rational mind is swamped by the emotional mind.

7. Misattribution of Arousal

8. Results of Poor Emotional Intelligence

9. Pre-frontal cortex – rational thought 2% Hypothalamus – emotional thought Amygdala – autonomic 98%

10. Relational • Contextual • Big Picture • Synthesis • Analytic • Sequential • Categorical • Literal Whole Brain Thinking

11. Key Idea #1 Conflict presents both Danger and Opportunity

12. Opportunity Pause Danger

13. Key Idea #2 In conflict we have choices

14. Collaborate Compete Compromise I S S U E Avoid Accommodate Relationship

15. Key Idea #3 In conflict we must Go Below the Line

16. Issues Positions Positions Go Below the Line Interests Interests

17. Key Idea #4 In conflict we must apply the Power of Process

18. People Product Process

19. Key Idea #5 The facilitation process helps people move through conflict

20. The Axelrod Theory for Avoiding Exploitation • Start with a cooperative moveThe move should be in process, not substance. • Match your response to their moveBe STRATEGICALLY competitive. • ForgiveIf someone is willing to be cooperative you should also be willing to be cooperative. • Be clear and be flexibleBe understood in both process and substance.

21. Promoting Mutual Gain • Ask questions • Listen to the unstated • Create all possible options • Develop realistic options • Evaluate options looking for mutual gain • Define alternatives to a collaborative outcome • Compare alternatives to collaborative options

22. The STAR Facilitation Process

23. St Joseph Medical CenterPhoenix, Arizona • 32 bed NICU • Level One Trauma Center • 1.7 Medicare Severity Index • Neuroscience Center of Excellence

24. Criteria for Eligibility • 96 hours intubation • 7 days of stay

25. Preparation for Intervention • Guidelines for decision-making at admission (English/Spanish) • Staff trained in facilitating EOL/CC concerns (4 hours) • After four day LOS, four page protocol inserted in patient chart • Implementation cost - $34,000

26. Pre-Intervention (102 patients) Post-Intervention (98 patients) Statistical Insignificance • 57.26 • 60% male • Intracranial hemorrhage • 19.6% • 5.2 • 35.1 • 21.7 • 17.5 • Age - 57.78 • Gender – 58% Male • Intracranial hemorrhage • Discharge • Home 22.9% • LTAC 16.7 • ECF/SNF 28.1 • Rehab 20.8 • Death 11.5

27. Statistical Significance Pre-Intervention Post-Intervention • Length of stay – 21 days • Intubation – 245 hours • Billed charges - $305,448 • 15 days • 206 hours • $241,132

28. Facilitated Health CareDecision-making • Better outcomes – LOS/Intubation • Less cost – 64,316 x 98 = $6,302,968 • Without litigation • Without government regulation • Higher patient satisfaction scores

29. It’s Complicated: Teams, Resources & Relationships Thomas A Hazinski Faculty Development Workshop Larry Bridgesmith, J.D. Steve Joiner, D. Min