III. Strategies for Addressing Stress and Conflict Within Health Care

8/11/2019 III. Strategies for Addressing Stress and Conflict Within Health Care

1/34

STRATEGIES FOR ADDRESSING STRESS AND CON FLICT WITHIN HEALTH CARE

2

III. Strategies for Addressing Stress and Conflict within Health Care

Conflict in the health care workplace

Managing conflict in the workplace is a time-consuming but necessary task for the nurse leader.

Conflicts may exist between physicians, between nurses and staff, and between the staff or the

health care team and the patient or patient's family. The conflicts may range from disagreements

to major controersies that may lead to litigation or iolence. Conflicts hae an aderse effect on

productiity, morale, and patient care

Managing Conflict in Healthcare

!ealthcare has always made for stressful workplaces. The high stakes nature of

healthcare plus too many patients plus oerworked staff plus the usual human frailties

and failings"people running late for their shifts, interdepartmental misunderstandings,

garden ariety personality clashes"add up to a lot of potential conflict. That#s not good

for patients.

The Exchange Strategy

$t deries from thirty years of mediation and conflict resolution experience and proides

leaders with a proactie, step-by-step process and uni%ue communication skills to

successfully resole conflicts.


2/34


3/34


4

6 + 7uild trust. Trust can#t be demanded. 7e sure to ask how each party is affected by the

conflict, and, secondly, what each person really needs.

Conflict-Resolution Skills as Patient Safety Tools

1imple conflict-resolution skills such as structured communication and collaboration as well as

more formal processes such as mediation are being used to resole conflict in a wide range of

formal and informal manners. These conflict-resolution skills and processes hae been used in

many domains, including health care. $t is finally becoming eident that the best way to resole

difficulties is for the parties inoled to get together and talk through their issues.

et In Touch !ith "our #eelings. 0s Mayer 8*999: has noted, ;Communication is at

the heart of conflict and resolution.; Conflict often arises from ineffectie

communication< effectie or assisted communication and positie collaboration promotes

successful resolution of differences. =umerous studies hae highlighted the connection

between poor communication and failures to collaborate as contributors to aderse

outcomes as well as affecting staff morale and staff retention. Hone "our $istening Skills. >hen it comes to effectie conflict resolution, how

effectiely we listen is at least as important as how effectiely we express ourseles. $t#s

ital to understand the other person#s perspectie, rather than just our own, if we are to

come to a resolution. $n fact, just helping the other person feel heard and understood can

sometimes go a long way toward the resolution of a conflict. ?ood listening also helps

for you to be able to bridge the gap between the two of you, understand where the

disconnect lies, etc.

Practice Asserti%e Co&&unication. Communicating your feelings and needs clearly is

also an important aspect of conflict resolution. The important thing to remember is to say


4/34


5

what#s on your mind in a way that is clear and assertie, without being aggressie or

putting the other person on the defensie. Seek a Solution. @nce you understand the other person#s perspectie, and they

understand yours, it#s time to find a resolution to the conflict -- a solution you both can

lie with. 1ometimes a simple and obious answer comes up once both parties

understand the other person#s perspectie. $n cases where the conflict was based on a

misunderstanding or a lack of insight to the other#s point of iew, a simple apology can

work wonders, and an open discussion can bring people closer together.

The following is a synopsis of the history of our awareness of stress'

Han Selyefurthered Cannon#s work by defining stress as the ;rate of wear and tear on the body;

and stressors as the ;causatie agents of stress; 8&A6B:. 1elye found that stressors may be

physical, such as infection, injury, and pain, or may be psychological, such as fear, anger, and

sadness. !e identified what he called a general adaptation syndrome 8?01:, whereby the body

seeks to maintain homeostasis or balance.

1eyle, 8olkman, &AD4: further recognied that stressors can lead to burnout and job fatigue if

there are no coping mechanisms in place - this is especially true for the professional nurse.

0ccording to the 0merican =urses 0ssociation, nurses report that there are many factors that

promote stress and lead to the classic Ecrash and burnF syndrome that many nursing

professionals experience.

The following are (ust so&e of the issues that nurses) face that often contri*utes to stress'


5/34


6

0nxiety related to demands of the job.

$nefficient coping related to the lack of knowledge for job re%uirements.

1piritual distress related to the inability to find meaning or purpose in professional and

personal life.

$neffectie leadership ability< ineffectie assertieness training.

$nability to motiate staff.

$neffectie ability to balance work, family, and personal life.

/ack of superisory support.

(oor co-worker relationship

These stressors can lead to the classic Eburn-outF syndrome. $nstead of persisting until this

happens, nurses can learn more effectie coping strategies, become self-aware, acknowledge

their own limitations, and ac%uire emotion-focused and problem-soling skills 81elye, &A6B:.

/ikewise, managers can proide physical and emotional support for staff members because

they alue them and understand the stressful nature of their work.

The following are se%eral strategies that nurses can use co&*at stress'

$earn to Identify #eelings. 7reaking through denial and admitting there's a problem is a step

toward finding solutions to stress. eelings can be named in one wordGbetrayal, guilt, anger,

sadness, frustration, etc... egistered =urses are trained to treat others with compassion, but
http://nursetogether.com/Lifestyle/Lifestyle-Article/itemId/991/Calming-Down-An-Intro-to-Stress-Solution-.aspxhttp://nursetogether.com/Lifestyle/Lifestyle-Article/itemId/991/Calming-Down-An-Intro-to-Stress-Solution-.aspxhttp://nursetogether.com/Lifestyle/Lifestyle-Article/itemId/991/Calming-Down-An-Intro-to-Stress-Solution-.aspxhttp://nursetogether.com/Lifestyle/Lifestyle-Article/itemId/991/Calming-Down-An-Intro-to-Stress-Solution-.aspxhttp://nursetogether.com/Lifestyle/Lifestyle-Article/itemId/991/Calming-Down-An-Intro-to-Stress-Solution-.aspx


6/34


7

unless they identify their own emotions, they can't generate compassion for themseles and

begin to heal. Hournaling, meditating and praying are strategies to help one get in touch with

those deep rooted inner feelings. 1imilarly, interests such as poetry, gardening, working, animals,

and painting are useful methods to unleash these deep rooted feelings.

Isolation Makes Things !orse. =urses, as professionals, are strong at caring for others, but

when it comes to them, they often beliee that they should be smart enough to handle things on

their own. This misconception often cuts them off from supportie listeners who can offer

constructie feedback. 0 safe place to talk without fear of judgment, reprisal, or breach of

confidentiality is a key tool of good self-care for nurses.

!riting +rings Clarity. Many nurses report that keeping a journal is a helpful method to put a

situation into perspectie. They can reiew the details and see if they should hae handled it

differently. 1imilarly, in order to ealuate professional and personal growth, it is often helpful to

read one#s journals written from preious years. 1uch writings can be helpful when the nurse has

her annual employment ealuation 8nurse together, *9&9:.

Rest and Rela,ation are ital. ecreation and hobbies are not luxuries< after all, eeryone has

the innate right to hae fun. $f we as nurses hae forgotten how to play, we can make an effort to

try new things or rediscoer actiities we used to enjoy.

%aluate and Rely on Spirituality. =urses often report fatigue and burnout related to their

inability to find meaning or purpose in their professional and personal life. 1imilarly, many rely

on spirituality for coping< and without any sense of spirituality, some nurses might be at a loss.


7/34


8/34


9/34


10

$t includes identifying the underlying concerns of the opponents and finding an

alternatie which meets each party's concerns.

,a&ples of when collaborating&ay *e appropriate'

>hen consensus and commitment of other parties is important $n a collaboratie enironment >hen it is re%uired to address the interests of multiple stakeholders

>hen a high leel of trust is present

>hen a long-term relationship is important

>hen you need to work through hard feelings, animosity, etc

>hen you don't want to hae full responsibility

Possi*le ad%antages of collaborating

/eads to soling the actual problem

/eads to a win-win outcome

einforces mutual trust and respect

7uilds a foundation for effectie collaboration in the future

1hared responsibility of the outcome

3ou earn the reputation of a good negotiator

or parties inoled, the outcome of the conflict resolution is less stressful


10/34


11

So&e ca%eats of collaborating'

e%uires a commitment from all parties to look for a mutually acceptable solution

May re%uire more effort and more time than some other methods. 0 win-win solution

may not be eident

or the same reason, collaborating may not be practical when timing is crucial and a

%uick solution or fast response is re%uired

@nce one or more parties lose their trust in an opponent, the relationship falls back to

other methods of conflict resolution. Therefore, all inoled parties must continue

collaboratie efforts to maintain a collaboratie relationship.

Co&pro&ising.Compromisinglooks for an expedient and mutually acceptable solution

which partially satisfies both parties.

,a&ples of when compromise&ay *e appropriate'

>hen the goals are moderately important and not worth the use of more assertie or more

inoling approaches, such as forcing or collaborating

To reach temporary settlement on complex issues

To reach expedient solutions on important issues

0s a first step when the inoled parties do not know each other well or haen#t yet

deeloped a high leel of mutual trust


11/34


12

>hen collaboration or forcing do not work.

Possi*le ad%antages of compromise'

aster issue resolution. Compromising may be more practical when time is a factor

Can proide a temporary solution while still looking for a win-win solution

/owers the leels of tension and stress resulting from the conflict

So&e ca%eats of using compromise'

May result in a situation when both parties are not satisfied with the outcome 8a lose-lose

situation:

Joes not contribute to building trust in the long run

May re%uire close monitoring and control to ensure the agreements are met

!ithdrawing. 0lso known as avoiding. This is when a person does not pursue herKhis

own concerns or those of the opponent. !eKshe does not address the conflict, sidesteps,

postpones or simply withdraws.

,a&ples of when withdrawing&ay *e appropriate'

>hen the issue is triial and not worth the effort

>hen more important issues are pressing, and you don't hae time to deal with it

$n situations where postponing the response is beneficial to you, for example -


12/34


13

>hen it is not the right time or place to confront the issue

>hen you need time to think and collect information before you act 8e.g. if you

are unprepared or taken by surprise:

>hen you see no chance of getting your concerns met or you would hae to put forth

unreasonable efforts

>hen you would hae to deal with ostility

>hen you are unable to handle the conflict 8e.g. if you are too emotionally inoled or

others can handle it better:.

>hen you see no chance of getting your concerns met or you would hae to put forth

unreasonable efforts

>hen you would hae to deal with ostility

>hen you are unable to handle the conflict 8e.g. if you are too emotionally inoled or

others can handle it better:.

Possi*le ad%antages of withdrawing'

>hen the opponent is forcing K attempts aggression, you may choose to withdraw and

postpone your response until you are in a more faourable circumstance for you to push

back

>ithdrawing is a low stress approach when the conflict is short

?ies the abilityKtime to focus on more important or more urgent issues instead


13/34


14

?ies you time to better prepare and collect information before you act

So&e ca%eats of withdrawing'

May lead to weakening or losing your position< not acting may be interpreted as an

agreement. 5sing withdrawing strategies without negatiely affecting your own position

re%uires certain skill and experience >hen multiple parties are inoled, withdrawing may negatiely affect your relationship

with a party that expects your action

S&oothing. 0lso known asAccommodating. 1moothing is accommodating the concerns

of other people first of all, rather than one's own concerns.

,a&ples of when smoothing&ay *e appropriate'

>hen it is important to proide a temporary relief from the conflict or buy time until you

are in a better position to respondKpush back

>hen the issue is not as important to you as it is to the other person

>hen you accept that you are wrong

>hen you hae no choice or when continued competition would be detrimental

Possi*le ad%antages of smoothing'

$n some cases smoothing will help to protect more important interests while giing up on

some less important ones

?ies an opportunity to reassess the situation from a different angle

So&e ca%eats of smoothing'


14/34


15/34


16

+. 3ecision &aking . The process by which members of an organiation choose a specific

course of action to respond to the opportunities and problems that confront them. ?ood

decisions help an indiidual, group, or organiation to be effectie. 7ad decisions hinder

effectieness and result in poor performance and negatie attitudes at all organiational

leels. Jecision making in response to opportunities occurs when members of an

organiation make choices or act in ways that result in benefits or gains.

The Rational Model4 +ounded Rationality4 and Intuition


16/34


17

Rational 3ecision Making

>e often think the best decision maker is rational and makes consistent, alue-

maximiing choices within specified constraints. These decisions follow a six-step rational

decision-&aking &odel.The rational decision-making model relies on a number of assumptions,

including that the decision maker has complete information, is able to identify all the releant

options in an unbiased manner, and chooses the option with the highest utility. 0s you might

imagine, most decisions in the real world don#t follow the rational model. (eople are usually

content to find an acceptable or reasonable solution to a problem rather than an optimal one.

Choices tend to be limited to the neighborhood of the problem symptom and the current

alternatie. 0s one expert in decision making put it, EMost significant decisions are made by

judgment, rather than by a defined prescriptiemodel.F

Steps in the Rational 3ecision-Making Model

&. Jefine the problem.

*. $dentify the decision criteria.

. 0llocate weights to the criteria.

4. Jeelop the alternaties.

6. Laluate the alternaties.

B. 1elect the best alternatie.

+ounded Rationality


17/34


18

@ur limited information-processing capability makes it impossible to assimilate and

understand all the information necessary to optimie. 1o most people respond to a complex

problem by reducing it to a leel at which they can readily understand it. 0lso many problems

don#t hae an optimal solution because they are too complicated to fit the rational decision-

making model. 1o peoplesatisfice; they seek solutions that are satisfactory and sufficient. ew

people made their college choice this way. $nstead of optimiing, you probably satisficed.

7ecause the human mind cannot formulate and sole complex problems with full rationality, we

operate within the confines of *ounded rationality . >e construct simplified models that extract

the essential features from problems without capturing all their complexity. >e can then behae

rationally within the limits of the simple model. !ow does bounded rationality work for the

typical indiidual2 @nce we#e identified a problem, we begin to search for criteria and

alternaties. 7ut the criteria are unlikely to be exhaustie. >e identify choices that are easy to

find and highly isible and that usually represent familiar criteria and tried- and true solutions.

=ext, we begin reiewing them, focusing on alternaties that differ little from the choice

currently in effect until we identify one that is Egood enoughF"that meets an acceptable leel of

performance. That ends our search. 1o the solution represents a satisficing choice"the first

acceptable one we encounter"rather than an optimal one.

1atisficing is not always a bad idea"a simple process may fre%uently be more sensible

than the traditional rational decision-making model. To use the rational model in the real world,

you need to gather a great deal of information about all the options, compute applicable weights,

and then calculate alues across a huge number of criteria. 0ll these processes can cost time,

energy, and money. 0nd if there are many unknown weights and preferences, the fully rational


18/34


19

model may not be any more accurate than a best guess. 1ometimes a fast-and-frugal process of

soling problems might be your best option.

Intuition

(erhaps the least rational way of making decisions is intuiti%e decision &aking , an

unconscious process created from distilled experience. $t occursoutside conscious thought< it

relies on holistic associations, or links betweendisparate pieces of information< it#s fast< and it#s

affectively charged, meaning itusually engages the emotions. >hile intuition isn#t rational, it

isn#t necessarily wrong. =or does it alwayscontradict rational analysis< rather, the two can

complement each other. 7ut noris intuition superstition, or the product of some magical or

paranormal sixthsense. 0s one recent reiew noted, E$ntuition is a highly complex and highly

deelopedform of reasoning that is based on years of experience and learning.F or most of the

twentieth century, experts belieed decision makers# useof intuition was irrational or ineffectie.

That#s no longer the case. D >e nowrecognie that rational analysis has been oeremphasied

and, in certain instances, relying on intuition can improe decision making. 7ut we can#t rely on

it too much. 7ecause it is so un%uantifiable, it#s hard to know when our hunches are right or

wrong. The key is neither to abandon nor rely solely on intuition, but to supplement it with

eidence and good judgment.

Co&&on +iases and rrors in 3ecision Making

Jecision makers engage in bounded rationality, but they also allow systematic biases and errors

to creep into their judgments. To minimie effort and aoid difficult trade-offs, people tend to

rely too heaily on experience, impulses, gut feelings, and conenient rules of thumb. These


19/34


20

shortcuts can be helpful. !oweer, they can also distort rationality. ollowing are the most

commonbiases in decision making.

5%erconfidence +ias $t#s been said that Eno problem in judgment and decision making is more

prealent and more potentially catastrophic than oerconfidence.F >hen we#re gien factual

%uestions and asked to judge the probability that our answers are correct, we tend to be far too

optimistic.

Anchoring +ias The anchoring *ias is a tendency to fi,ate on initial infor&ation and fail to

ade%uately adjust for subse%uent information. $t occurs because our mind appears to gie a

disproportionate amount of emphasis to the first information it receies.0nchors are widely used

by people in professions in which persuasion skills are important"adertising, management,

politics, real estate, and law.

Confir&ation +ias The tendency to seek out information that reaffirms past choices and to

discount information that contradicts past judgments.

A%aila*ility +ias The tendency for people to base their judgments on information that is readily

aailable to them.

scalation of Co&&it&ent 0n increased commitment to a preious decision in spite of

negatie information.


20/34


21

Rando&ness rrorThe tendency of indiiduals to beliee that they can predict the outcome of

random eents.

Risk A%ersion The tendency to prefer a sure gain of a moderate amount oer a riskier outcome,

een if the riskier outcome might hae a higher expected payoff.

Reducing +iases and rrors

/ook for $nformation That Jisconfirms 3our 7eliefs. @ne of the most effectie means for

counteracting oerconfidence and the confirmation and hindsight biases is to actiely

look for information that contradicts your beliefs and assumptions. >hen we oertly

consider arious ways we could be wrong, we challenge our tendencies to think we#re

smarter than we actually are.

Jon#t Try to Create Meaning out of andom Lents. The educated mind has been trained

to look for cause-and-effect relationships. >hen something happens, we ask why. 0nd

when we can#t find reasons, we often inent them. 3ou hae to accept that there are

eents in life that are outside your control. 0sk yourself if patterns can be meaningfully

explained or whether they are merely coincidence. Jon#t attempt to create meaning out of

coincidence.

$ncrease 3our @ptions. =o matter how many options you#e identified, your final choice

can be no better than the best of the option set you#e selected. This argues for increasing

your decision alternaties and for using creatiity in deeloping a wide range of dierse

choices. The more alternaties you can generate, and the more dierse those alternaties,

the greater your chance of finding an outstanding one.


21/34


22

Indi%idual 3ecision Making

$ndiiduals think and reason before they act. This is why an understanding of how people make

decisions can be helpful for explaining and predicting their behaior. $n some decision situations,

people follow the rational decision-making model. 7ut few important decisions are simple or

unambiguous enough for the rational model#s assumptions to apply. 1o we find indiiduals

looking for solutions that satisfice rather than optimie, injecting biases and prejudices into the

decision process, and relying on intuition.

!hat can &anagers do to i&pro%e their decision &aking6

0nalye the situation. 0djust your decision-making approach to the national culture

you#re operating in and to the criteria your organiation ealuates and rewards. 0djust

your decision approach to ensure its compatible with the organiation#s culture.

1econd, be aware of biases. Then try to minimie their impact.

Third, combine rational analysis with intuition. These are not conflicting approaches to

decision making. 7y using both, you can actually improe your decision-making

effectieness. 0s you gain managerial experience, you should feel increasingly confident

in imposing your intuitie processes on top of your rational analysis.

inally, try to enhance your creatiity. 0ctiely look for noel solutions to problems,

attempt to see problems in new ways, and use analogies. Try to remoe work and

organiational barriers that might impede your creatiity.


22/34


23

C. 0egotiation . $s the process in which parties with conflicting interests meet together and

make offers, counteroffers, and concessions in the attempt to resole their differences.

=egotiation is an important techni%ue that managers use to increase the likelihood of

reaching compromise between indiiduals and groups in conflict. Through negotiating

and bargaining, the parties to a conflict discuss different ways to allocate resources in

order to reach a solution acceptable to them all.

+argaining Strategies

There are two general approaches to negotiation" distributive bargaining and integrative

bargaining.

3istri*uti%e *argaining .=egotiation that seeks to diide up a fixed amount of resources< a

win+lose situation.

Integrati%e *argaining.=egotiation that seeks one or more settlements that can create a win+

win solution.

$n terms of intraorganiational behaior, all things being e%ual, integratie bargaining is

preferable to distributie bargaining because the former builds long-term relationships.

$ntegratie bargaining bonds negotiators and allows them to leae the bargaining table feeling

they hae achieed a ictory. Jistributie bargaining, howeer, leaes one party a loser. $t tends

to build animosities and deepen diisions when people hae to work together on an ongoing

basis.

3istri*uti%e ersus Integrati%e +argaining

+argaining Charcteristics 3istri*uti%e +argaining Integrati%e +argaining

Goal ?et as much of the pie as Lxpand the pie so that both


23/34


24

possible parties are satisfied

Motivation >in-lose >in-win

Focus (ositions 8E$ cant go beyond

this point on this issue.:

$nterests 8ECan you explain

why this issue is so important

to you2F:

nterests @pposed Congruent

nformation sharing /ow 8sharing information will

only allow other party to take

adantage:

!igh 8sharing information will

allow each party to find ways

to satisfy interests of each

party:

!uration of relationship 1hort term /ong term

The 0egotiation Process


24/34


25

Preparation and Planning 7efore you start negotiating, you need to do your homework. >hat#s

the nature of the conflict2 >hat#s the history leading up to this negotiation2 >ho#s inoled and

what are their perceptions of the conflict2 >hat do you want from the negotiation2 >hat are

your goals2

3efinition of round Rules @nce you#e done your planning and deeloped a strategy, you#re

ready to begin defining with the other party the ground rules and procedures of the negotiation

itself. >ho will do the negotiating2 >here will it take place2 >hat time constraints, if any, will

apply2 To what issues will negotiation be limited2 >ill you follow a specific procedure if an

impasse is reached2 Juring this phase, the parties will also exchange their initial proposals or

demands.

Clarification and 7ustification >hen you hae exchanged initial positions, both you and the

other party will explain, amplify, clarify, bolster, and justify your original demands. This step


25/34


26

needn#t be confrontational. ather, it#s an opportunity for educating and informing each other on

the issues, why they are important, and how you arried at your initial demands. (roide the

other party with any documentation that helps support your position.

+argaining and Pro*le& Sol%ing The essence of the negotiation process is the actual gie-and-

take in trying to hash out an agreement. This is where both parties will undoubtedly need to

make concessions.

Closure and I&ple&entation The final step in the negotiation process is formaliing the

agreement you hae worked out and deeloping any procedures necessary for implementing and

monitoring it. or major negotiations" from labor+management negotiations to bargaining oer

lease terms to buying a piece of real estate to negotiating a job offer for a senior management

position"this re%uires hammering out the specifics in a formal contract. or most cases,

howeer, closure of the negotiation process is nothing more formal than a handshake.

Indi%idual 3ifferences in 0egotiation ffecti%eness

Personality Traits in 0egotiation.=egotiators who are agreeable or extraerted are not ery

successful in distributie bargaining. >hy2 7ecause extraerts are outgoing and friendly, they

tend to share more information than they should. 0nd agreeable people are more interested in

finding ways to cooperate rather than to butt heads.

Moods8&otions in 0egotiation. 0ngry negotiators also feel more focused and assertie in

striking a bargain. This appears to hold true een when the negotiators are instructed to show


26/34


27

anger despite not being truly angry. @n the other hand, for those in a less powerful position,

displaying anger leads to worse outcomes.

0nxiety also appears to hae an impact on negotiation. or example, one study found that

indiiduals who experienced more anxiety about a negotiation used more deceptions in dealing

with others.

Culture in 0egotiations

ender 3ifferences in 0egotiations

0 popular stereotype is that women are more cooperatie and pleasant in negotiations than are

men. The eidence doesn#t support this belief. !oweer, men hae been found to negotiate better

outcomes than women, although the difference is relatiely small. $t#s been postulated that men

and women place une%ual alues on outcomes.

R59P 3"0AMICS

0AT9R 5# R59PS A03 TAMS !ITHI0 HA$TH CAR

0 group is a a collection of two or more people who work with one another regularly to

achiee common goals

is often depicted as a collection of people sharing leadership of and working together on a

specific project. 8Lrofee, ?laer, $anitskaya, *99A:


27/34


28

a team can eole from a pre-existing group. !oweer, a group by itself cannot be

considered a team. 0 team tends to be more close knit and works together oer a longer

period of time than a group. 0 team also holds a stronger sense of collectie identity than

a group.

RAS50S #5R R59P #5RMATI50

&. !ae a sense of security*. !ae a status

. Jeelop self-esteem

4. 0ffiliation6. (ower

ffecti%e groups achie%e high le%els of'&. Task perfor&ance - members attain performance goals.

*. Me&*ers satisfaction - members beliee that their participation and experience are

positie and meet important personal needs.. Tea& %ia*ility - Members are sufficiently satisfied to continue working together on an

ongoing basis

Situations in which groups are superior to indi%iduals'

>hen there is no clear expert in a particular problem or task

>hen problem soling can be handled by a diision of labor and the sharing of

information >hen creatiity and innoation are needed.

ASS5CIAT3 PR5+$MS I0 R59PS


28/34


29

S5CIA$ #ACI$ITATI50. The tendency for a person#s behaiour to be influenced by

the presence of others.

positiely affects performance when a person is proficient in the task

negatiely affects performance when the task is not well-learned.

S5CIA$ $5A#I0. $s the tendency of people to work less hard in a group than they

would indiidually.

$ndiidual contributions are less noticeable in the group context

1ome indiiduals prefer to see others carry the workload

!ays of pre%enting social loafing

&. Jefine member roles and tasks to maximie indiidual interests

*. /ink indiidual rewards to performance contribution to the group

. aise accountability by identifying indiidual#s performance contributions to the group

A. roup 3yna&ics. Concerns the forces operating within groups that affect the way

members relate to and work with one another. ETeamwork and collaboration between all

health professionals results in high %uality clinical care, and increased job satisfaction for

staffF87egley, *99A:

!hat goes on within a group6

&. e%uired behaiours-those formally defined and expected by the organiation

-norms that are expected to each members*. Lmergent behaiours

-those that group members display in addition to what the organiation asks of them

+. Types of roups

#5RMA$ R59PS-formally defined by the organiation#s structure

-designation of work assignments are formally established 8T. H5J?L, *9&&:

I0#5RMA$ R59PS

-neither formally structured nor organiationally determined-natural formations in the work enironment that appear in response to the need for

social contact


29/34


30

C. roup 3e%elop&ent

Tuck&an)s #i%e Stages of roup 3e%elop&ent

: Stages of roup 3e%elop&ent

#or&ing

- ?roup is initially coming together.

- (eriod is characteried by shyness, and uncertainty among members.

-Lxtraerted outspoken members may rapidly assume some kind of leadership role.

- Maintenance concerns are predominating.

- >hy are we here2 >hat are we doing2

- >hat is our goal, our purpose2

- 0wareness, $nclusion.

Stor&ing

- @nce established - period of ying for positions and roles within the group.

- 1ome seek out and compete for status, control, authority and influence.

- $nner conflict. 0 period of ;testing-out; the leaders.

- Jisagreements and arguments arise, are fuelled and manufactured.

- $n the end, roles are eentually allocated.- The initial leaders may not surie this periodG it is the most uncomfortable phase of

the group's life - akin to adolescence.

0or&ing

- $nternal group structure now sorted, ?roup $dentity takes shape.


30/34


31

- >hat kind of behaiors contributions are acceptable and normalied within the

group2 >hat is not tolerated2

- ormation of - $mplicit Lxplicit ?roup =orms.

- =orms create structure >hat do we stand for2- ?roup can readily slip back into 1torming stage.

- Cooperation.

- Cohesion.

Perfor&ing

- >ork and progress commences on the basis of a relatiely stable group structure.

- Moing in unison, towards goals and completion.

- 0ction, esults.

- (roductiity.

- Team cohesion and identity.

Ad(ourning

- Completion and disengagement.

- 1eparation and ending from tasks and members.

- (ride and accomplishment may be felt.

- 1ome describe stage as ;Jeforming and Mourning; - recogniing the sense of loss

felt by group members.

3. Roles within roups


31/34


32

$ncreasing costs of health care and rapid knowledge growth hae led to collaboration among

health care professionals to share knowledge and skills.

P9RP5SS'

To characterie the %ualitatie nature of team interaction and its relation to training health

professionals, drawing on theoretical and analytical frameworks from the sociocognitie

sciences.

MTH53S'

0ctiities in a primary care unit were monitored using obserational field notes,

hospitaldocuments, and audio recordings of interiews and clinical interactions.

RS9$TS'

The demarcation of responsibilities and roles of personnel within the team became fuy in

practice. Continuous care was proided by primary care proiders and specialied care by

intermittent consultants. The nature of indiidual expertise re%uired was a function of the patient

problem and the interaction goal. These team characteristics contributed to the reduction of

unnecessary and redundant interactions.

C50C$9SI50S'

Jistributed responsibilities allow the team to process massie amounts of patient information,reducing the cognitie load on indiiduals. The uni%ueness of indiidual professional expertise

as it contributes to the accomplishment of team goals is highlighted, suggesting emphasis on

conceptual competence in the deelopment of indiidual professionaleducation programs.

. 3CISI50 MA;I0

(also known as collaborative decision making) $s a situation faced when indiiduals collectiely make a choice from the alternaties

before them.

This decision is no longer attributable to any single indiidual who is a member of the

group

!hy roups can &ake higher /uality decision6

according to Gary John, there are three assumptions that for basis on this argumentN ?roups are more igilant than indiiduals

N ?roups can generate more ideas and deelop more alternatie solutions than indiiduals


32/34


33

N ?roups can ealuate ideas better than indiiduals

I&portance of /uality decision &aking

-The %uality of decision is important, and the same may be made by the manager himself

or by the group. The same may be in the following scenariosG

N The extent to which the manager possesses the information and expertise to make a high-

%uality decision

N The extent to which the subordinates hae the necessary information to assist in

generating high-%uality decision

N The probability that the manager#s decision will be accepted by the subordinates

N The extent to which the subordinates would go to attain organiational goalsN The extent to which acceptance on the part of the subordinates is critical to effectie

implementation of the decisionN The extent to which the subordinates are likely to disagree oer preferred solutions

Types of roup 3ecisions'

&. 9nilateral - a decision made by one person, often the nominal leader, without

consultation with other group members. 0t times, it can be appropriate. or example, a

minor decision that needs to be made right away. $f it is repeated and inappropriate, this

type of decision can carry a ery low group commitment.*. Handclasp- decisions made by two members. @ne suggests, the other endorses and

carries it through without ade%uate discussion or group consideration. This type has high

commitment for the two who made it, but generally not for the others.

. Cli/ue- similar to the !andclasp but with more people inoled. This type usually

occurs when a close sub-group decides what is good for the rest of the group. epeated

cli%ue decisions cause splintering of the group and low commitment.

4. +aiting - a techni%ue that reduces discussions around decisions. 0 person will say, ;=ow

we are all agreed, right2); and only the ery brae will speak up. This usually suppresses

obious dissention and lowers group commitment.

6. Ma(ority Rule- a popular way of making decisions. !oweer, if the outcome of a secret

ballot ote would produce any surprises, it is not a good time to make majority rule


33/34


34

decisions. >hat happens is that a sieable segment of the group may feel dealued and

decrease their commitment to the decisions in which they ;lose; to the majority ote.

B. Consensus - similar to Majority ule, but eeryone knows that what they think and alue

is being considered by all, and there will be no surprises if you ote. Lach person will

agree that, under the circumstances, which may not be ideal, the decision made is a fair

and workable one that they can lie with and support.

A3A0TAS 5# R59P 3CISI50 MA;I0

&. ?roup members may hae different specialties

*. More alternaties are examined. $mplementation of the decision may be more efficient

4. Lliminates biases6. Jemocratic in nature

3ISA3A0TAS 5# R59P 3CISI50 MA;I0

&. Time consuming*. The group#s decision may be dominated by one indiidual or a small coalition

. @wn interests to protect

4. $ndiiduals may be compelled to conform to the apparent wishes of the group

6. ?roupthink + the tendency of highly cohesie groups to lose their critical ealuation

capabilities

Reference'

0ppelbaum, 1. 8*9&*:. Stress Manage&ent for Health Care Professionals ?4@:-@@


34/34


35

Chernis, C. 8*9&9:. Staff *urnoutG (o* stress in the hu&an ser%ices BR3edition p. >-

D4 @==-@=?4

III. Strategies for Addressing Stress and Conflict Within Health Care

Documents

Transcript of III. Strategies for Addressing Stress and Conflict Within Health Care