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???