Training. NHS Conflict Resolution

Transcription

1 Training NHS Conflict Resolution In this module we will look at interpersonal conflict, warning signs of possible conflict situations, and ways of dealing with conflict safely and effectively. Conflict Conflict happens. Typically it happens when the goals and/or actions of one or more parties appear to at least one party to be incompatible those of another. It can be a destructive force, but when managed in a positive and constructive way conflict can provide new opportunities to grow and 'move forward'. Being able to view conflict in this manner is the key to successful conflict resolution. The best way to resolve a conflict is usually to negotiate a peaceful solution in a manner that is acceptable to all parties and that ultimately improves the relationship between the parties. Unfortunately real life conflict situations have a habit of lasting more than just a few seconds. Unresolved conflicts can go on and on, festering and deepening in an ever more destructive downward spiral, so it's best to resolve conflicts as soon as possible. Festering conflicts are extremely unhelpful on many levels; they drain time, energy, motivation, and reputations, lead to all kinds of unpleasant situations and can create high enough levels of stress to be seriously detrimental to the health. It's important to realise that stress is usually a major factor in conflict. It can cloud judgement, severely affect your ability to communicate, grasp what others are communicating and it can mask your own real needs and feelings. Communication Effective communication is vital in the workplace.in health care, the incorrect passage of information can have disastrous effects. It is important for us to communicate information effectively and to the appropriate people. In modern society there are numerous forms of communication these include: face-to-face, written (including letters, s and instant messaging), via telephone or video phone, and many more. Some of these may be mixed and may in themselves contain a mix of verbal and non-verbal communication. It is important to select suitable forms of communication, be skilled in their use and have an understanding of the possible limitations. Communication, good or bad usually has a major role to play in conflict situations. Good communication is a powerful tool for conflict resolution (and conflict prevention) whilst bad communication can server to trigger or deepen conflict. As a minimum, communication of a message requires both an originator and a receiver, this immediately gives rise to two possible points of failure. A badly articulated communication is likely to lead to misunderstanding. A well articulated communication may also be misconstrued. Verbal (spoken) communication is advantageous because it normally allows for a two-way discussion in which the parties can interact for purposes of clarification and avoidance of misunderstandings. Verbal communication is perhaps most effective when it is face to face because it can be combined with non-verbal cues.

2 Non-Verbal Communication It is said that two thirds of communication is non-verbal. As such, its impact and role in conflict situations should never be underestimated. Non-verbal communication includes: Facial expressions Eye contact: Patterns of gaze play an important role in establishing relations between people and regulating interpersonal communication Posture: How we stand and walk Gestures: Actions that send a visual signal e.g. pointing, waving, clenching of fists. Haptics (touch): Who or what we touch, and how and where can all convey meaning. Proxemics (distance): This is our personal space, how close we let people approach can convey much information. The above kinds of non-verbal communication are sometimes referred to as body language. Other types include: Dress: In all societies clothes are used to send all sorts of information about the person who is wearing them. Paralanguage: The tone, pitch and volume of our voice and the emphasis and inflection we place on individual words also have an extremely significant effect on how the actual words we say will be interpreted. Communication Failure Along with the very obvious difficulties in communicating caused by language barriers, non-verbal cues can be interpreted very differently by different cultures, warning signs may go unnoticed and serious misunderstandings can ensue.for example, whilst certain cultures might avoid direct eye contact as a sign of respect, others might see and evasion of eye contact as a sign of untruthfulness. Whilst a handshake might be perceived as suitable in the UK, this is not necessarily the case in all cultures. Different cultures also have different expectations relating to personal space. Unproductive types of communication include using inappropriate gestures such a finger wagging, adopting an aggressive posture or facial expression, or use of an inappropriate tone of voice. Some other examples of unhelpful communication include: the use of excessively technical terminology, uncommon/ambiguous idioms, or perhaps offensive language; or providing too little (or too much) information; or inaccurate information. Sometimes communication is made purely with malicious intent. Communication is also commonly impeded in persons: with mental disorders; under effects of alcohol or drugs; experiencing pain, or high levels of distress or anger; and those with auditory or visual impairment, or speech difficulties. Environmental factors such as high noise levels or lack of privacy can also create difficulties in communicating effectively. Discussions need to be held in appropriate surroundings.

3 An all too common cause of communication failure is the insistence of one party talking over another. It is of the utmost importance to listen to the other party, andmany conflict situations arise or are perpetuated by the inability of a complainant to properly state their case and be listened to. Of course it is only possible to listen and understand if the other party is actually saying something coherent.prompting with open questions like "What happened?" or "Can you explain the problem in detail?", and clarifying e.g. "So let me make sure I understand correctly - You are saying...?" should be thought of as parts of effective listening. Communication Models One of the most important ways of avoiding conflict is being able to recognise the potential threat in your situation. When a conflict arises, it is vital to attempt to communicate with your complainant or aggressor. Let's take a look at four communication models, all of which can help with effective communication in conflict situations: SAFE; LEAPS; PEACE and PALMS. SAFE reminds you to prioritise safety, it is an acronym for: Step back Stop and think - Do not rush into a situation Assess the threat Identify potential dangers Find Help think what help you may need, or who you need to communicate with. Evaluate options decide what options are available to you, choose the one most likely to work and then respond in a professional manner LEAPS is about understanding a person's point of view, an acronym for: Listen - to what the person is saying Empathise - Use phrases such as I can understand why you are upset or I can see that this has made you angry Ask questions - to help discover and clarify the facts Paraphrase - Demonstrate that you have been listening and understand the situation Summarise - establish an agreement and a way forward PEACE is about fairness and focusing on the problem, is an acronym for: Pick the right strategy Enable voices to be heard Attack problems, not people Create options

4 Evaluate PALMS (open palms) is about body language, principally adopting a non-threatening stance that invites communication: Position - think about how you position yourself to the other person, and make sure you do not block any exits as this will make the person feel trapped Attitude - be positive and helpful Look and Listen - make normal eye contact and display that you are listening Make space - consider personal space for both yourself and the other person Stance - relaxed posture All of these models can help the communication with a complainant or aggressor, either to prevent a conflict or to bring it under control. Aggression can be broadly divided into four types: Hostile: The most basic form of aggression that is caused by anger Instrumental: It is often part of an emotional outburst Cognitive: This type of aggression is driven by the desire to achieve something rather than feelings of anger getting our own way whatever the cost Learned: How our past experiences and thoughts affect our understanding and interpretation of a situation; we learn through rewards or seeing the behaviour rewarded in others. A learned behaviour can be replaced with more appropriate one. Warning Signs Before Conflict It is important to be able to recognise as soon as possible when an incident is escalating to a point where you, or another person, is in danger of being physically assaulted so that if this happens you will have time to prepare to handle it in a way that calms the situation and minimises the risk to yourself and others. The following warning and danger signs are not intended to be complete lists, they are merely examples of the kinds of non-verbal clues that sometimes manifest as aggression builds. Typical warning signs are: Extended eye to eye contact Standing tall Head tilted back Exaggerated breathing rate

5 Face colour darkening or reddening Exaggerated body movements Erratic behaviour Kicking something or stamping on the floor Any of the following danger signs might indicate an even higher risk of imminent physical aggression... Intense staring Body lowered Tightened lips Hands raised above waist height Chin dropped Eyebrows dropped Face colour paler Shoulders tense Safety and Assessment of Impact Factors The safety of yourself and of others around you should always be your primary concern. If you notice any warning or danger signs of conflict escalating, step back from the situation and maintain a safe distance. This distance, sometimes called a reactionary gap, is a distance which allows verbal communication whilst providing safety from possible physical attack by giving you time to think and react. Typically you should maintain a distance of the maximum of your own reach, and the maximum of the possible aggressor's reach. If an aggressor has a weapon, the effective reactionary gap will need to be greater. Ask them to put the weapon down (but not to hand it over). Wherever possible try to move towards a safe place where there are other people. Don t isolate or trap yourself, keep out of corners and away from stairs and other potential obstacles. In order to be able to deal properly with, or avoid, a possible physical confrontation it is important to get an objective understanding of the degree of risk which might arise. Always make an assessment of impact factors by considering what will be the positive or negative impact of the following factors: Persons: (them and you) e.g. height/build, age, gender, mental/physical state Environment: e.g. exit routes/obstacles, security facilities, ability to summon assistance

6 Situation: What are you tasked with? What is the likelihood of a dangerous situation arising?it is safer or more dangerous now than at a different time? Ways of Dealing with Conflict People tend to deal with conflict using one of five styles: Avoidance or Denial: Refusing to face up to the existence of a conflict situation can sometimes be useful in conflicts that are genuinely trivial and best forgotten, or which need settling-down time before they can be addressed properly, however in the latter case it can also lead to long-term unresolved, festering issues. Competitive: Taking a firm stand an enforcing a position can be useful if an emergency decision needs to be made; however refusing to accept another party's position usually leads to lasting feelings of resentment. It's a win-lose outcome. Cooperative:A cooperative or collaborative conflict resolution involves all parties in working to find and invest in mutually agreeable solutions that will result in a win-win outcome. Compromising: A compromising or conciliatory solution is one which emphasises fairness and goes some way to appeasing everyone. Everyone is expected to make concessions. It can be an effective resolution strategy if time or resources are limited. Yielding: Yielding is appropriate when the issues are more critical to the other party and when the prospect of peace is more valuable than winning. Behaviour Breeds Behaviour It is extremely unlikely that you will always have a positive attitude towards everyone you meet in the course of your work. Some people, for any number of reasons, will cause you to have negative feelings towards them. If you are dealing with someone you feel negative towards, you are likely to show those negative feelings in the way that you behave towards that person. If the other person recognises this negative behaviour from you, this may in turn affect their attitude towards to you. A negative attitude will come out in their behaviour towards you and their negative behaviour is then likely to strengthen the negative feelings you had in the first place. It can become is a vicious cycle of increasingly negative attitudes and negative behaviour. It is crucial to develop an awareness of your own expressions, behaviours and actions, and how they affect the person you are speaking with. Try to find ways to develop a positive attitude and reverse the negative cycle. My Attitude -----> My Behaviour -----> Your Attitude -----> Your Behaviour Your attitude is displayed by your behaviour which in turn will affect the attitude of the person you are talking to, and their behaviour. Show empathy, using phrases like: "I understand your concerns" or "I can understand why you are annoyed"

7 but avoid reinforcing the problem by saying things such as: "Yes it is terrible isn't it" "This happens all the time" "It is really annoying isn't it" When dealing with conflict situations where people are showing signs and symptoms of aggression: 1. Maintain self-control; 2. Ask for the aggressive behaviour to stop. (you signal non-aggression); 3. Respond assertively, but not confrontationally; 4. Listen for feelings, not only what is being said; 5. Identify the root cause of the problem without making any assumptions; 6. Try to divert focus away from the problem to normalise the situation; 7. Humour can be useful but be sure you're laughing with them not at them; 8. Stay positive and refer to past strengths and experiences; but 9. If you feel out of your depth, request help from a trained mediator. Never attempt to deal with someone who is armed unless you have been specially and specifically trained to do so. Instead you should summon appropriate assistance! If a situation becomes truly dangerous the only options left to you may be escape or to use physical restraint. In some exceptional circumstances or if escape has failed, you may have to exercise your right to selfdefence, or defend others, using reasonable force. If this is the case, the best course of action is usually to create an opportunity to escape.in almost all cases, the best escape route is towards where you think you will find other people. Reasonable force is a legal concept (Criminal Law Act 1967), which is generally considered to mean that any force used should be proportionate and necessary in the circumstances. Seeking Support It is important that all staff who may have been involved in or been affected by a violent or abusive incident is able to seek short term and long term support if needed. Providing support to the person affected by an incident and their colleagues could help to reduce the risk of longer-term, stress-related illness. This applies to incidents of verbal abuse as well as physical violence. The support will be determined by type and level of abuse and/or violence you were exposed to. You should not be left alone, this can be when you are most vulnerable Others may want to be left alone make sure it is a safe and secure place You should be given an opportunity to talk The police may have to be notified, give as much information to them as possible to enable them to support you

8 You should be offered access to counselling services. These may be offered either in-house or from local professionals such as Victim Support or GP services. Ensure that staff are fully trained and competent, if it is in house. If needed, you should be given necessary time off to recover, but research has shown that staff benefit from returning to work as soon as they are able after a traumatic incident When you do return to full duties, avoid working in situations that could restart your symptoms, or lead to longer-term, stress-related illness. Security Management Service The Security Management Service (SMS) is part of the Counter Fraud and Security Management Service (CFSMS), a division of the NHS Business Services Authority (a Special Health Authority). It has overall responsibility for all policy and operational matters related to the management of security in the NHS. On behalf of the Secretary of State for Health, it determines the policies, legal framework, operational guidance and minimum standards necessary to provide a secure environment for the NHS. It also gives central and regional support to those charged with security management work in health bodies, so these standards can be met. Areas of priority action include tackling violence against NHS staff; security of drugs, prescription forms and hazardous materials; security of NHS property and assets; and security of maternity and paediatric units. Two national legal frameworks were introduced, in November 2003 to tackle violence and general security management issues in the NHS. It is the responsibility of the Chair/Chief Executive of all NHS health bodies to designate an Executive Director or Officer to the role of SMD. The responsibility for security management remains firmly with the SMD, regardless of whether or not the LSMS and/or security staff are directly employed by the health body or provided by an external contractor. The role of the Local Security Management Specialist (LSMS) The SMD has overall responsibility for the nomination and appointment of a suitable individual to the role of LSMS for their NHS health body and for subsequent liaison with and monitoring of the LSMS, ensuring security management work is of the highest standard whether the LSMS is employed by the NHS health body or an accredited external contractor. NHS Protect NHS Protect works to protect NHS staff and resources from crime. It has national responsibility for tackling: Fraud Violence Bribery Corruption Criminal damage Theft

9 Other unlawful action such as market-fixing NHS Protect has three main objectives: To educate and inform those who work for or use the NHS about crime in the health service and how to tackle it To prevent and deter crime in the NHS by removing opportunities for it to occur or to re-occur To hold to account those who have committed crime against the NHS by detecting and prosecuting offenders and seeking redress where viable. Proceed to Questions