for effective teams & relationships

Transcription

1 Leadership & Management Education for effective teams & relationships 20 Oct 2017 Diane de Camps Meschino MD Mcert FRCPC Anupam Thakur MD-Psychiatry MSc(Med. Ed) Co-Chairs Leadership Curriculum, University of Toronto, Department of Psychiatry

2 I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization. Je n ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d appareils médicaux ou un cabinet de communication. 2

3 Leadership & Relationships Challenger: What can we learn about teams? 3

4 CanMEDS Leader Role 3.1 Demonstrate leadership skills to enhance health care 3.2 Facilitate change in health care to enhance services & outcomes Patient experience & outcomes; Lead teams Emphasis: EI- self aware, self regulation, empathy, social skill, relationships Motivation Quality & safety CanMEDS

5 Objective 1: Apply Relational-Cultural Theory to understand improve power dynamics in teams RELATIONSHIPS MATTER: WHAT DO WE KNOW? 5

6 Relational-Cultural theory Stemmed from scholarly examination of the impact power dynamics on oppressed people Acknowledges: Inherently social nature of human beings Diversity & power differentials Culture affects relationships significantly Goal: peaceful co-existence & mutual empowerment Jean Baker Miller Training Institute 2013; Judith V. Jordan et al 2004; Jennifer Llewellyn 2012 Beyond Intractability: 6

7 Relational-Cultural Theory Absence of mutuality é psychological problems é violent conflict Disconnection disrupts / denies relational nature: é human suffering West C 2005 Mutuality Implications for conflict: need for reconnection Experiences that éconnection é pro-social behaviour McCauley M

8 Application of R-CT Awareness Real or perceived power differential has consequences Culture & experience may colour interpretation Behaviours Be explicit about the possible impact of power differential Explicit about purpose of leadership Authenticity Name when distracted Ask often- personal, team safety; Ask for feedback 8

9 Objective 2a: Apply SCARF model (Neuroscience of Leadership) improve teams functioning and relationships RELATIONSHIPS: PATIENTS, COLLEAGUES, TEAMS 9

10 Team function-5 critical factors *Psychological safety- ability to take risks by sharing ideas Dependability Structure & clarity Meaning of work Impact of work Cultivating Great Teams: What Health Care Can Learn from Google Catalyst NEJM; Blog post ; February 21, 2017 Jessica Wisdom, PhD, Henry Wei, MD 10

11 The neuroscience of leadership Brain responds to perception of threat or reward in relationships Behaviour may hide internal response: flight, fight, freeze/collapse Typical reward motivators? Typical threat motivators? 11

12 Powerful Rewards & Threats (SCARF-neuroscience) Status in relation to others Certainty Autonomy Relatedness friend / foe Fairness êin status real or perceived é strong threat response brain looks for certainty small uncertainty causes error response having a choice ê level of stress belonging to a group collaborating & sharing information élevel of trust "unfair" éthreat response transparency communication & participation = positive Rock D. Youtube: ; What is your strong suit; others? 12

13 Challenger: what went wrong Policy certainty without safety certainty Political pressure: disempowered, perceived threat status Managers ignored experts: autonomy, trust Communication system disconnected: no mutual relationship; hierarchy Values and ethics: no one resigned 13

14 SCARF Exercise: Increase awareness self & other Describe a time when a change of SCARF produced threat and how experienced Status: specialty; shaming comments Certainty: change in department strategic plan; illness; financial Autonomy: hours; # complex patients; focus on efficiency only Relatedness: toxic workplace; criticism; humiliation, misinterpretation Fair: favouritism, nepotism, inequity pay, workload 14

15 Leadership vs Hierarchy Leaders who flatten out the hierarchy promote informational exchange (safe) more effective leaders Aviation Studies: macho personalities less team coordination» Marie Guise J, Segel S 15

16 Mapping to R-CT & SCARF to Team leadership: What & How Empowering Status Listening Inclusion Respect Diversity 1. American Hospital Association ß g_as_a_team.pdf 2. IOM 2012 Right personnel Clear goals & decisions with collective Empowers members to speak up Promotes communication Accountable: outcomes Conflict resolution Relatedness Connected Trust Plans Certainty 16

17 Objective 2b: Apply Karpman s triangle improve teams functioning & relationships TEAM FUNCTIONING & RELATIONSHIPS INTRA-PROFESSIONAL, DEPARTMENTS, ORGANIZATIONS & SYSTEMS 17

18 Conflict is normal Healthy: Difference of opinion What can be learned by different approaches? Unhealthy: Abuse Drama script- perceiving & acting according to early experience Universal some of the time Destructive to teams & relations if much of the time May occur in silence How to diffuse the emotion? 18

19 The Karpman Drama Triangle Largely unconscious, roles: Persecutor, Rescuer, Victim acted-out in daily life that are unstable, unsatisfactory, repetitive, & emotionally competitive. Principles See all three roles Roles can suddenly switch up Every person involved will feel upset Win-lose always turns into lose-lose Karpman S 2005: 19

20 Example Patty was staying with her friend Mary and Mary s daughter, Ann. One day a pair of Patty s earrings came up missing and she asked if anyone had seen them. Everyone said no. Suspicious of Ann, Patty went into her bedroom and looked in her jewelry box. And, they were there! Patty took them back and announced where she had found them. Patty was clearly the Victim here (of Ann s obvious theft). And, the Persecutor was clearly Ann (the thief). Mary became the Rescuer by chastising her daughter, Ann. However, Ann denied taking the earrings and all the roles suddenly switched. Now, Patty was seen as the Persecutor (falsely blaming Ann who was now the Victim). Mary stood up for her daughter Ann, and became the Rescuer. Then, asked Patty to leave her home which made Patty the Victim and Mary the Persecutor.. and so the drama continues. Karpman S

21 Persecutor Stance: It s all your fault - Sets strict limits unnecessarily Blames and Criticizes Keeps Victim oppressed Is mobilized by anger Has rigid, authoritarian stance If you find yourself in this Role, get off the Triangle, by feeling/empathizing; taking responsibility. Karpman S

22 Victim Stance: Poor me - Feels victimized, oppressed, helpless, hopeless, powerless, ashamed Looks for a Rescuer who will perpetuate their negative feelings If stays in Victim position, will block self from making decisions, solving problems, feeling any pleasure, and selfunderstanding. Maintains dejected stance If you find yourself in this Role, get off the triangle getting help with problem solving. Karpman S

23 Rescuer Stance: Let me help you - Rescues when really doesn t want to Feels guilty if doesn t rescue Keeps Victim dependent Gives permission to fail Expects to fail in rescue attempt If you find yourself in this Role, get off the Triangle, by giving help without enabling ; allow the person to help themselves; to learn, and grow, by solving their own problems. Accepting Help to Change old Habits Karpman S

24 Name the role (large group) John: I can't believe you burnt dinner! That's the third time this month! P Mary: Well, little Johnny fell and skinned his knee, it burned while I was busy getting him a bandage. R John: You baby that boy too much! Mary: You wouldn't want him to get an infection, would you? I'd end up having to take care of him while he was sick. V P 24

25 KT: Victim, Persecutor, Rescuer John: He's big enough to get his own bandage. Mary: I just didn't want him bleeding all over the carpet. R R John: You know, that's the problem with these kids! They expect you to do everything! Mary: That's only natural, honey, they are just young. John: I work like a dog all day at a job I hate... R V R 25

26 KT: Victim, Persecutor, Rescuer Mary: Yes, you do work very hard, dear. John: And I can't even sit down to a good dinner! Mary: I can cook something else, it won't take too long. John: A waste of an expensive steak! Mary: Well maybe if you could have hauled your ass out of your chair for a minute while I was busy, it wouldn't have gotten burned! P P R V R 26

27 KT: Victim, Persecutor, Rescuer John: You didn't say anything! How was I supposed to know? P Mary: As if you couldn't hear Johnny crying? You always ignore the kids! P John: I do not, I just need time to sit and relax and unwind after working all day! You don't know what it's like... V Mary: Sure, as if taking care of the house and kids isn't WORK P 27

28 Getting Off The Triangle Step 1. Become aware when you re in the Drama Triangle Step 2. Identify the role you ve been assigned & ask: Is this a comfortable role? A familiar role? Am I aware of personal history with this role? Etc. Step 3. What new action is called for? Remember: Real victims exist disasters In conflict Victims after age 18, are volunteers. Karpman S

29 Role Identification and Action act/do Persecutor rescuer watch/wait feel/empathize responsibility victim Karpman S

30 Exercise: Stepping of the Triangle What could each say to stop the script? Create a non defensive response Articulate what the leader did at the end 30

31 Application Self awareness What reaction am I having? How am I interpreting comments by? Which role? How can I respond to empower the patient, colleague, team Awareness of other Did they respond defensively? Which role? How can I respond to diffuse? 31

32 3 EMBED IN RESIDENT CURRICULUM 32

33 Reflection Exercise Incorporation of KT and SCARF model into residency practice & education to enhance TEAMs and relationships Teams meetings Projects Discussion with supervisors, mentors Workshops Use as framework when setting up a team Other 33

34 Questions 34

35 Thankyou 35

36 References Jean Baker Miller Training Institute, "The Development of Relational-Cultural Theory Eisenburger N, Lieberman M, "Why it Hurts to be Left Out: The Neurocognitive Overlap Between Physical and Social Pain." The Social Outcast: Ostracism, Social Exclusion, Rejection, and Bullying 2005, 37. Guiseeanne J, Segel S, MDTeamwork in obstetric critical care. Best Pract Res Clin Obstet Gynaecol Oct; 22(5): Jordan JV, Hartling LM, Walker M, The Complexity of Connection, (New York: Guilford Press, 2004): 3-6. Karpman s Triangle; Accessed Sept 2017 Llewellyn J, Being Relational: Reflections on Relational Theory and Health Law, (Vancouver: UBC Press, 2012): 4. McCauley M. Relational-Cultural Theory: Fostering Healthy Coexistence Through a Relational Lens Rock D., SCARF: a brain-based model for collaborating with and influencing others. NeuroLeadershipjournal 2008(1). SCARF Self assessment: Saltman DC, O Dea NA, Kidd MR., Conflict management: a primer for doctors in training. Postgrad Med J Jan;82(963):9-12. Seeman M., Lewis S., Powerlessness, health and mortality: A longitudinal study of older men and mature women; Social Science & Medicine. 41 (4) Tilden VP, Eckstrom E, Dieckmann NF., Development of the assessment for collaborative environments (ACE-15): A tool to measure perceptions of interprofessional teamness, Journal of Interprofessional Care, :3, West C., "The Map of Relational-Cultural Theory," Women & Therapy, 28, no. 3-4 (2005): 103.ß 36

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