[MUSIC] In this video, we'll discuss strategies for managing conflict that will almost inevitably arise during change initiatives. We are changing something, we're doing things differently, obviously. There are many people involved, many different perspectives. It's best to have a proactive approach to identifying potential conflicts and resolving them effectively, efficiently, and in a way that builds stronger relationships. So that's what we're going to focus on for the next few minutes, and we'll start with an example. This is John's story. John is scheduled for a colorectal surgery in the morning, but he's allergic to penicillin. The team's done a great job of identifying that, flagging that in a record, and it can be dealt with. Recently, there's been a new protocol implemented at this facility. And based on the research available, the infection control group has recommended a new regiment for people who are penicillin allergic, and this includes both clindamycin and gentamicin of those dosages. The new recommendations are rolled out. Frontline staff are told what these are, provided with the supporting data and rationale for the change, but the physicians involved, at least some of them, are skeptical. This is a big change, it's twice the dose of gentamicin that's typically given on the wards. And there's some fear that there's a risk for patients' care there that might cause actual damage. Before John's surgery, he's prescribed clindamycin without the gentamicin because of those physician fears. And when John gets to the floor, the floor RN, who's aware of these new changes, thinks that he should be on gentamicin as well. Because that's the new protocol that's been rolled out and because she's been provided with that evidence. The attending physician, however, is not receptive to that information from the nurse, and she says that maybe when you get an MD, we'll talk about what you think, right? So not particularly receptive, not particularly agreeable, but pushes back pretty strongly. So the whole time, the physician is thinking that this is my patient, John is my responsibility, and it's my call, it's my decision. The nurse is thinking that I don't know what to do. I'm really worried about the patient. He's not being treated with the protocol that's been rolled out in the organization, and potentially, there's some risk there as well. So this illustrates the type of conflict that can come up that is very common when new changes are rolled out and not everyone is on board with them. The change we talked about came from infection preventionists. But it sounds like maybe all of the physicians weren't engaged in the process of setting that standard, or weren't completely on board with that as a standard of care. So we want to think about the conflict that can arise, where it comes from, and really the nature of it, and we want to think about this in terms of two related buckets of conflict. So we can have task-related conflict, which is where we have discrepancies about goals we're trying to reach, or the process we're going about to reach that. So in this case, everyone, I believe, had the same goal, the best possible care for John. But there were some discrepancies in terms of what was the best path for reaching that goal, what regimen was best for him. And then there's interpersonal conflict as well, and this is more stylistic. It's not about the patient, it's not about our goals, it's not about what's best for the patient. It's stylistic between us, it's personal between us. We maybe don't like each other or aren't effective working together because of those issues, and we want to make sure that those are separate. We want to deal with the task-related conflict because that is where most of the interpersonal conflict comes from. And we think back to the example, and the interaction that the physician had with the nurse, that can damage the relationship. That was disrespectful, that was dismissive, those two people will not likely have a productive working relationship moving forward. It could have been dealt with better if we focused on what was right for the patient and coming to agreement on that. This conflict come from scarce resources. Time being one of the biggest scarcities we have. Differences in goals and values, those are both sources of task-related conflict. The incompatible interaction styles is a piece of interpersonal mismatches, and poor communication hurts us across both of those categories. That can really create challenges for managing tasks effectively, but also for building and managing our personal relationships. So what are some strategies for managing conflict? Broadly, there are active and there are passive strategies. So active, we're seeking out discrepancies that we have and seeking to resolve them. Passive, we're avoiding them at all costs, and those are obviously very different approaches and yield different ends. And there's, of course, agreeable versus disagreeable strategies, and this has to do with the stylistic piece of it. Agreeable is we're seeking to reconcile our differences in a way that maintains respect and dignity for all involved. Disagreeable, we're less concerned with that. We may still be focusing on John's care, what's best for John, our goals, but we're not necessarily attentive or attuned to the interpersonal dynamics involved. And it's not too surprising, but active and agreeable approaches work the best. So within the context of a change initiative, what are some techniques that you can use? And one that we want to focus on, which is rooted in a lot of the principles we've been talking about so far. About having an open, participatory, transparent process, and a fair process for a change initiative, is this idea of inquiry and advocacy. So when we were advocating within the context of this protocol, we're seeking to create buy-in for our perspective. We're advocating for our approach. We want to make sure that our goals, our ideas, our rationale, our reasoning, and our evidence are clearly understood. We've done this job communicating those and resolving of the task-related conflict that might come up. And we're encouraging others to engage with that perspective, with that idea, with what we've put forward, to propose alternatives or modifications, to let us know where that is not working as effectively as we believe it may. We want that input, and we want to be receptive to that, and we want to explore the alternatives honestly, legitimately, and thoroughly. So in the inquiring phase of this, we really want to seek to understand other people's perspective on the change, or on the issues we're trying to address. Our goal is to learn what their perspectives are. And to use their insights, their wisdom, to inform our own understanding of the situation, of the organization, of what our ideas of an effective intervention may be. We're going to ask people to generate examples of what they mean if they raise a question, they raise a concern, or they're trying to describe what the problem looks like from their nature. We want them to be concrete in providing some ideas of what they're talking about. We want to ask them what their assumptions are, or try to understand what their assumptions are, that are leading them to their position or to their conclusion. And we want to know if they have any data behind what they're proposing or what they're trying to support. Basically, we're trying to surface all of the hard, and all of the loose evidence that they may have around their position. So that we can think through this collectively and come up with a better solution. There will almost always be bumps in the road. So what do you do if you hit a roadblock during these conversations where you're attempting to resolve conflict? Some good advice, to start from the beginning, is encouraging people to think aloud. We want to understand what their thought processes are, what their rationales are for their positions. If possible, we would also like to avoid scheduling later meetings to resolve any conflict we have. Many times that allows people to become more entrenched in their own position, in their own thoughts, and they become less receptive to other people's ideas or arguments. We want to also offer people the opportunity to brainstorm together. I can put aside our assumptions, or our perspectives, our positions, and let's come at this freshly together and generate ideas on what the problem is or what effective solutions will be. And then we also want to explore ideas, how to test our competing assumptions or plans. If there are multiple ideas on what's going to be most effective, are there ways to empirically look at which one will be more feasible, which one will be more effective. There are many other ways and strategies to address conflict resolution. It's helpful to think of those in terms of the task conflict and the interpersonal conflict. The task conflict strategies involve clarifying,intentions, clarifying information, and making sure we are on the same page in terms of goals, in terms of our plan, surfacing any differences and dealing with them. So the CUS technique is just drawing attention to a problem, I'm concerned, I'm uncomfortable, this is a safety issue. And the two-attempt rule involves making sure, if we are dismissed in our position, making sure we raise that at least a second time to make sure people heard and understood what our concern is. Interpersonal conflict, again, is much more difficult to deal with, and this can involve hostile or harassing behavior. There are scripts for those, and you have links to review those further in the course materials. So, in summary, change almost inevitably creates the opportunity for conflict. For disagreements, disconnects in our understanding of what are goals are or what an effective process might look like. We want to be proactive in reducing the risks, especially for task conflict. And this comes back to being clear on our communication for the plans for change, our rationales for change, and the motivations behind change. And, of course, we always want to be active, proactive, and surfacing conflict and dealing with it in agreeable in our approaches. Making sure people are respected, and that we maintain effective professional interpersonal relationships. And the inquiry and advocacy approach can be a helpful technique to use throughout a change process to surface and manage conflict in a proactive and agreeable way.
