Dysfunctional Teams
Instructor Name
Learning Objectives
Describe types of conflict and various management approaches
Use a basic framework to problem-solve
Develop techniques to assist a difficult team member
Conflict
No one likes it Adds to stress Can destroy team dynamics Can influence career goals Can influence personal life
Some Conflict is Good
Leading cause of business failure among major corporations → Too much agreement among top management”
Lack of tension → Complacency Essential, ubiquitous part of
organizations
Reflection
Reflect on a time when you had conflict w/ a person (or a team) that didn’t function well
Describe it What was the problem? How did you handle it?
Types of Conflict
Issues Decision-making Topic-oriented
People Emotional Feeling of resentment Relationships
Conflict Management Approaches
Forcing – Getting your way Avoiding – Ignore, don’t deal Compromising – Agreement
quickly Accommodating – Don’t upset
other person (taking advantage of you?)
Collaborating – Solve the problem together
Example You are one of 2 residents on GI wards You both want a GI fellowship Your colleague is constantly
interrupting you on rounds, contradicting you
They are making you look bad Rounds lose focus, drag on, important
issues lost Confused attending and interns
Example cont’d You are bitter and angry You tell everyone how awful he/ she
behaves You refuse to give up your weekend off
to help him/her You confront the resident, tell them to
back off, YOU are killing me, and I can’t wait until
this month is over . I hope I don’t have to work with you again!
What would have been a better solution?
Should you have involved others in the solution? If so, who?
Is timing an issue? Could this have been headed off before it escalated?
General Framework for Collaborative Problem-Solving
Establish common goals Separate the people from the
problem Avoid making conclusions or
judgments Encourage 2-way discussion
Objective criteria to measure outcome
Establish Common Goals
Focus on what both parties share in common We both want a GI fellowship We both want to spend time with our
families and have weekends off We both want what is best for the
patient
Separate the People from the Problem
Depersonalize the situation Make the issue the behavior not
the person People get less defensive Easier to resolve conflict
XYZ Approach
When you (behavior), then (consequences), and I feel (feeling)…
XYZ Approach
Example 1: Interrupt me on rounds
When you interrupt me on rounds, we both look bad to the attending and I feel like you are hurting our chances for fellowship.
XYZ Approach
Example 2: Resident interrupts intern on rounds
When you interrupt me on rounds, then I can’t communicate my plan and I feel like my learning is affected .
XYZ Approach
Example 3: Intern ignoring nurses pages
When you ignore the nurses pages, the patient suffers, and I feel like you are not taking your responsibilities seriously. Do you want to be a doctor?
XYZ Approach
Example 3: Intern ignoring nurses pages
When you ignore the nurses pages, then you aren’t accessible in an emergency, and I am concerned the patient may suffer.
Better approach!!
Avoid Making Conclusions or Judgments
Don’t say: You are lazy! You are wrong! You are mean!
Make It a 2-way Conversation
Do say: Do you realize you are doing this? How were you taught to do this? You don’t seem engaged - Help me
understand what’s going on. Is there a reason you are struggling? How can I help you? What have you
tried already?
Continue until Understood
Keep your opening statement brief The longer your opening, the more
worked up you get, the more defensive the other person becomes, the longer it takes to find a resolution
Ensure understanding Clarify, ask questions This is important for both of us
Objective Criteria to Measure Outcome
How will you know if your conversation worked? How can we evaluate our plan? Keep track of a measure?
Number of interruptions, hours on rounds Less tantrums
Let’s try it, and in 2 days sit down and reassess
Be Nice
Agree with something (if you can) Yes, it’s stressful worrying about
fellowship. I remember getting annoyed with so
many pages, especially when many weren’t important, but …
Be Nice Approach multiple problems
incrementally Choose your battles Basic problem first
We’ll work on more later (i.e., next problem)
I want this to be a great month and I want to help you learn
Example
Using your earlier example Working in pairs or a group
How could you have handled your situation better?
General Framework for Collaborative Problem Solving
Establish common goals Separate the people from the problem Avoid making conclusions or
judgments Encourage 2-way discussion Continue until understood Objective criteria to measure outcome
The Difficult Learner
There seems to always be at least one!!!
Difficult Learners?
Dealing with a difficult learner is a teacher’s worst nightmare
Human nature – Blame the learner Coping Strategy – Ignore the
learner Difficulties are not always 1-sided
Interpersonal skills involve 2-people
What to Do
Become better acquainted w/ learner Understanding his/her perspective =
possible solution . . . . sooner! Inform leaner, “I am committed to
your learning.” Take the problem seriously – don’t
ignore
Why Are Some Learners Difficult?
List several reasons why you think some people struggle or are “difficult” learners
Reasons for Difficult Learners Stressed Sick Poor coping skills Frustrated with a
lack of support Feel vulnerable Feel scared
Family situation Drugs, alcohol Financial strain Tired May not know any
better …
Categories Capacity
Lack physical / mental capacity to cope Cognitively inadequate or unable Personality traits
Motivation Distractions
Outside work (domestic, financial) Appear disorganized, can’t make decisions,
make mistakes
Specific Behaviors & Suggestions to Consider Slow
Familiarize learner w/ time expectations Poor knowledge or skills
References, suggestions, give extra time
Fear of failure Provide expectations & feedback “Mistakes are expected” “Think out loud to help me better
understand your reasoning”
Specific Behaviors &Suggestions to Consider
Poor interactions, interpersonal skills Make sure he/she understands how
others perceive his/her actions XYZ Approach works well here
Unmotivated - Most difficult Provide clear expectations Change the behavior, not the personality Grade accurately
For the Biggest Problems
Don’t be afraid to involve the clerkship or program directors
We all have a vested interest
Medicine is a profession Keep it that way
General Framework for Collaborative Problem Solving
Establish common goals Separate the people from the problem Avoid making conclusions or
judgments Encourage 2-way discussion Continue until understood Objective criteria to measure outcome
References
Whetten D, Cameron K, Developing Management Skills, 7th edition, Pearson Prentic Hill, 2007
BMJ Career Focus 2002;325:S43 Mahan,The Clinical Teaching
Handbook, Ohio State University College of Medicine, 2007
Questions???