The Exchange Strategy for Managing Conflict in Health Care delivers a wealth of strategies and techniques for structuring conversations about conflicts and issues in groups large and small.
"A fresh, clear-eyed view of how to approach conflict in the American healthcare system . . . shows how direct, immediate, tactful, and open communication will greatly improve any workplace setting." -- KATHLEEN SELLICK, President and CEO, Rady Children's Hospital
"Having worked in large hospital systems for many years, I wish I had known these skills and techniques when I supervised nurses and coordinated teams." -- KIM PHILLIPS, MSN, RN, CFCN, Nurse's Touch, Inc.
"During the past 12 months, over 450 managers and supervisors on my team at Sanford Health have gone through this training, and it works!" -- EVAN BURKETT, Chief Human Resources Officer, Sanford Health
"The strategy and skills laid out in this book . . . are truly effective. Ignore this at your peril." -- DR. SAMUEL B. HO, Chief, Gastroenterology Section, Veterans Affairs San Diego Healthcare System, Professor of Medicine, University of California, San Diego
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About the Author
Steven P. Dinkin has directed the National Conflict Resolution Center since 2003, where he has spearheaded the effort to bring conflict resolution training to the workplace. Barbara Filner has designed and conducted workshops on mediation and conflict resolution in the workplace in the United States and Europe. Lisa Maxwell has been a mediator since 1985 and, as director of NCRC's Training Institute, is the lead designer of The Exchange Strategy.
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THE EXCHANGE STRATEGY FOR MANAGING CONFLICT IN HEALTHCARE
How to Defuse Emotions and Create Solutions when the Stakes are High
By STEVEN DINKIN, BARBARA FILNER, LISA MAXWELL
The McGraw-Hill Companies, Inc.Copyright © 2013National Conflict Resource Center
All rights reserved.
Welcome to The Exchange at St. Sonia's
Radha Samson reached for the phone at her desk, pushed the extension button for Drew Thompson, the head of Employee Relations at St. Sonia's Hospital, and said, "Hey, Drew, I've got another Exchange job for you. You need to get on it ASAP! Dr. Phillips called me just now to complain. One of his patients was upset by a 'fight' between two nurses. He claims it's a patient safety situation. Apparently, the elderly woman he's been working with had an alarming rise in her blood pressure when she heard her favorite nurse, RN Simon Peters, being berated by RN Yvette Jones. Naturally, he wants someone fired. I calmed him down by assuring him we'd set up an Exchange process. While he's a little skeptical, apparently he's heard enough about it to be at least momentarily satisfied. He's a great doctor—apparently he relates well with his patients—but his relations with the staff need some work, and I'd like to keep this situation from becoming worse. He had already talked to the nursing manager to complain but he wasn't sure she would take care of it, despite the fact that she said she would. I'd really like to settle this at the lowest level possible."
Drew Johnson responded, "Hmm, that would be Kim Brown. She is very clear about patient care as well as nursing standards for the nurses on the floor. Whatever he might think, she's a very good nurse manager. She hasn't yet facilitated a full Exchange process, but she did cofacilitate one with me, and she did a great job. And she has a good way with her staff. They respect her and if she wants them to meet, they'll meet. Can you give me some more details?"
Radha replied, "I don't know a whole lot, but apparently Yvette Jones and Simon Peters are involved, and they have a history of not getting along. This actually sounds like a perfect scenario for The Exchange. I'm so glad that we had most of our supervisors and managers take part in that training last fall."
Drew sighed and said, "Okay, I'll call Kim as soon as we hang up and see what I can find out. I'll let you know how it goes."
Radha ended the conversation, "Thanks, Drew. And good luck!"
After hanging up with Radha, Drew took a deep breath and decided that rather than call the nurse manager, Kim, about the incident, he would walk over to her office and talk to her. He wanted to make sure that Kim felt supported and knew that he was willing to coach her if there were difficulties.
Kim Brown, Head Nurse in Geriatrics, was responsible for everything that happened on her floor of the hospital, especially the work and interactions among the nurses. Because of her competence, as well as her personal skills, she had earned the respect of both patients and nurses, who felt free to come to her with their problems. When she had called the patient, Alma Cruz, to get more details concerning this latest complaint, the nurses' argument, she realized that something would have to be done about this long-simmering personality conflict.
When Kim saw Drew come into her office, she realized that the conflict was affecting more than just one patient and one floor of the hospital. Before he had a chance to say anything, Kim said, "I bet I know why you're here, Drew. Did Dr. Phillips call you too? I am going to conduct The Exchange with these two nurses, but I would really appreciate your support in this. I don't feel completely confident with The Exchange process yet, even though I know it works."
Drew replied, "Kim, I came specifically to assure you that I am glad to help. In fact, I told Radha that I could function as coach and we could talk as the process unfolds. I'm relieved that you have already thought about this and I agree that on first glance, The Exchange sounds like the perfect vehicle. So what do you know about the conflict?"
Kim began, "So Radha already knows about this? I suppose Dr. Phillips called her?"
Drew responded, "Good guess. You know Dr. Phillips. He's quick to advocate for his patients, which is great. And he always goes straight to the top and to every other position he thinks might help. Let's just say he covered his bases on this one."
Kim grimaced and said, "Yeah, I know. But I still wish he had stopped with me. I told him I would take care of it."
Drew wanted to remain positive, so he didn't respond to the last comment. Instead, he asked, "So what's the story? What have you heard?"
Kim filled Drew in, "Well, apparently, yesterday, Alma Cruz, who is one of Dr. Phillips's heart patients, heard two nurses arguing loudly right outside her room. She's particularly fond of Simon Peters and believed that another nurse was unfairly accusing him of giving inadequate care or something. Alma has very high blood pressure and this is what alarmed Dr. Phillips. He noticed a spike in her pressure when he was checking her during his rounds, and he came right over to complain. I've since found out that my hunch was right that the other nurse involved was Yvette Jones. Both Simon and Yvette are excellent nurses but have very, very different personalities. I guess Yvette was irritated by what she considers Simon's inability to separate himself professionally from his patients. I don't know what else. But I'll find out when I meet with each of them each for Stage One in about a half hour. Your timing is amazing, Drew. Can I check in with you after I meet with them?"CHAPTER 2
The Exchange: A Proven Approach to Conflict Resolution
At St. Sonia's Hospital, The Exchange process is a key part of their Integrated Conflict Management System (ICMS). For those unfamiliar with the concept of ICMS, it is a graduated system for addressing conflicts. At its lowest level, only the disputing parties are involved. Individuals are encouraged to make an effort to speak to the person they perceive has offended them. Because of this, many organizations that have an ICMS system of conflict resolution offer communication skills workshops so employees can gain skills in giving and receiving effective feedback.
If the one-on-one discussion is not successful or is not attempted, people can contact their supervisor or manager, who then can convene and facilitate an Exchange process. The Exchange is an ideal process for the next step. At times, neither employee has initiated a conflict resolution process but the manager sees a need to convene one. Most disputes are resolved at this point, but there are other levels available should they be needed, including professional mediation by an outside neutral.
Many healthcare facilities, as well as corporate businesses, schools, and other institutions, have adopted such a system as a way to manage the conflicts that occur in every workplace. We're talking about the kinds of conflicts that, if not addressed, result in enormous costs, both financial and personal. Unaddressed conflicts or mismanaged conflict resolution procedures result in high staff turnover, low morale, and expenses associated with litigation, which in turn lead to a poor work product and an unacceptable bottom line.
In the healthcare industry, the fundamental concern of patient safety may be threatened by these conflicts. There have been studies to indicate that these conflicts, which are most often rooted in miscommunication or lack of communication, can even lead to medical mistakes. When human beings are involved, accidents and resulting errors will always happen, but some errors are not accidents. Errors caused by lack of a clear understanding of what is needed or by the inability of individuals to speak up constructively for themselves in an inherently hierarchical culture are not inevitable. It is possible to greatly reduce the occurrence
Excerpted from THE EXCHANGE STRATEGY FOR MANAGING CONFLICT IN HEALTHCARE by STEVEN DINKIN, BARBARA FILNER, LISA MAXWELL. Copyright © 2013 by National Conflict Resource Center. Excerpted by permission of The McGraw-Hill Companies, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Foreword by Evan Burkett
PART ONE Introductions
CHAPTER 1 Welcome to The Exchange at St. Sonia's
CHAPTER 2 The Exchange: A Proven Approach to Conflict Resolution
PART TWO The Four-Stage Exchange Model
CHAPTER 3 The Exchange, Stage One: The Private Meetings
CHAPTER 4 The Exchange, Stage Two: Developing the Agenda
CHAPTER 5 The Exchange, Stage Three: The Joint Meeting
CHAPTER 6 The Exchange, Stage Four: Problem Solving
PART THREE Using The Exchange in the Workplace
CHAPTER 7 The Classic Exchange: One Manager, Two Employees
CHAPTER 8 Adapting The Exchange to Manage a Disruptive Employee
CHAPTER 9 The Exchange Aikidoist: How to Use the Techniques When You Are
CHAPTER 10 Using The Exchange to Coach an Employee When Bosses Are
CHAPTER 11 Using The Exchange Techniques with Patients
CHAPTER 12 The Exchange and Patients' Families
CHAPTER 13 Using The Exchange in Group Conflicts
PART FOUR Beyond the Workplace
CHAPTER 14 Using Exchange Techniques on Yourself
CHAPTER 15 The Exchange: Will It Work at Home?
CHAPTER 16 Epilogue at St. Sonia's Hospital
APPENDIX A Communication Skills for The Exchange
APPENDIX B Sentinel Event Alert, July 9, 2008, Issue 40