dealing with difficult behavior
TRANSCRIPT
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Dealing with Difficult
Behavior
Mamta Gautam MD, MBA, FRCPC, CPDC, CCPE
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Objectives
1. What is disruptive behavior?
2. Why does it occur?
3. How can we best manage it?
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Disruptive Behaviors
• Incivility, acts of disregard, rudeness
• Personal and unprofessional verbal attacks
• Impertinent and inappropriate comments or in written form
• Sexual harassment of staff, peers, patients
• Intimidating, belittling, non-constructive criticism
• Requiring unnecessarily burdensome activities of staff, unrelated to work to be done
• Public criticism of colleagues, dept, hospital
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Bullying
• a form of aggression, “the assertion of power
through aggression”
• incivility that is pervasive and ongoing; a
pattern of behaviour
• intended to intimidate, harm, offend, degrade
or humiliate a particular person or group of
people
2008 Crisis Prevention Institute Inc.
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Occasional outbursts can be normal
responses to stress at home or at
work
This is not our focus.
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Possible Causes
• Anger in Grief and Loss
• Stress and Burnout
• Substance Abuse
• Psychiatric Disorders – depression, anxiety,
manic episodes, obsessive-compulsive
behaviors
• Personality Disorders – antisocial,
narcissistic, histrionic
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Anger is always a
Secondary Emotion.
Identify what is
underlying it.
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Remember that we can appear quite
intimidating.
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Anger in Grief
• Anger is normal part of the Grief Reaction
• Expect it.
• Do not personalize.
• Allow it.
• Help the person identify the loss, and grieve
it.
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Ten Types of Personality Disorders
• Cluster A: Odd, Eccentric, socially awkward
• Paranoid
• Schizoid
• Schizotypal
• Cluster B: Dramatic, emotional
• Antisocial
• Histrionic
• Narcissistic
• Borderline
• Cluster C: Anxious, fearful
– Avoidant
– Dependant
– Obsessive Compulsive
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Cluster B Personality Disorders
• 1-3% of adult males
• 0.5-1% adult females
• Some cultures encourage and reward such
characteristics.
• Seek out and promote this – high achievers,
charming, good for business
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Common Characteristics
• Lack remorse or guilt
• Superficial charm
• Grandiose self-worth
• Impulsive, spontaneous
• Prone to boredom
• Manipulative, lying, splitting
• Highly functioning and successful
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People with a Personality Disorder
don’t know they have one.
View their symptoms as strengths!
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People with a Personality Disorder do not
behave consistently…
Or do they?
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Three Main Features
1. Lack insight, accept no responsibility
2. Projection
3. Splitting
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Our Usual Responses
Want to be nice, understanding, avoid conflicts, positive and hopeful
• Let behavior go - deny
• Look the other way - minimize
• Hope it stops - rationalize
• Avoid direct discussion
• Become frustrated
• Eventually, leads to confrontation
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Self Awareness
• Identify past incidents when others were
angry.
• What is your usual response to anger?
• Understand your own anger before you
can deal with someone else’s anger.
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Why is it difficult to address?
• Makes us uncomfortable
• People tend to avoid conflict
• Feel disloyal to colleague
• Feel won’t be believed or heard, have no
power
• Worry about burden of proof, liability
• Fear of reprisals
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Why should we address it?
• Costs to the person
• Costs to their family
• Costs to the coworkers
• Costs to the organization
• Costs both emotional and financial
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Key points
• You can only change your own behavior.
However, you can create conditions which
can encourage others to make different,
more effective behavioural choices.
• Lack of insight can contribute to poor
behavioural choices
• Feedback creates conditions for personal
reflection and change
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At organizational level
• Ensure that your department has:
– Clearly articulated cultural values regarding
communication, respect, professionalism
– Zero tolerance policy for disruptive behavior
– RCPSC Policy on Harassment and Intimidation
– Consider visual signs and reminders
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“What you permit, you promote.”
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At individual level
• Intent: Positive, compassionate
• Timely: Intervene early
• Privacy: Set limits with the person directly, privately
• Address each incident specifically, with suggestions
for improvement. Focus on behaviors and facts,
not people and interpretations
• Focus on clear expectations for conduct
• Ask them to tell you so you know they heard it
• Expect and prepare to deal with their anger
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Managing Your Own Anger
• Acknowledge it - Every feeling is OK; it’s how
we express it that is/not OK.
• Write out feelings - use the Four Letter
Technique.
• Pick the fights you want to fight.
• Relax, stay calm.
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Consider in a Confrontation
• Before: If. Use Rule of Thirds.
If so, Why?
• During: Who, What, When, Where,
How?
• After Possible Outcomes?
Avoid CLM’s.
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Conflict Management is easy,
until you get ANGRY.
“Anger is when the tongue works faster than the mind.”
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The best way to take the
wind out of someone’s sails
is to
AGREE with them.
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Managing Anger from Others
MY FOUR A’S:
1. Admit, agree
2. Acknowledge
3. Apologize
4. Act
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Conflict Resolution
Four Key Steps:
1. Define your needs.
2. State your needs.
3. Listen to the other person state their needs.
4. Negotiate a compromise.
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CONFLICT RESOLUTION
• Decide on your “Bottom Line”
• Be specific and direct. Use documented facts to support your views.
• Use I/Me Statements
• Broken Record. “Yes…and” bottom line
• Give constructive suggestions, not just complaints.
• Don’t get stuck on Solutions; focus on Needs.
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• You do not deserve to be yelled at.
• Say:
“Stop. I do not like to be yelled at.”
“I will discuss this later / in private.
• If continues later, repeat as above.
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The Bully
• enjoys hurting people and making them cry - not want a productive relationship.
• becomes a bully because others freeze at the thought of confronting them.
• will trivialize your concerns.
• needs to be called on their behavior:
“I beg your pardon...That sounds like an insult, did you mean it that way?”
• Name the behavior, tell them you do not like it, tell them to stop.
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Setting Limits
• Acknowledge : “It’s clear that...”
• Commit Involvement : “I’ll help you sort it out”. This is optional.
• Describe: “Words like...When I get told that..”
• Effect: “..I get defensive...I shut down...I can’t hear what you’re telling me”.
• Specified/Preferred Scenario: “I want you to slow down and tell me what you want...”
• Consequence: Mutual, positive.“That way, we can work together to solve this...sort it out”.
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Don’t give away the control over how
you are going to feel that day!