The effect of a "micronegotiation" technique on team interactions.

Author:Kaufman, Jeffery
Position::Report
 
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INTRODUCTION

When conflict exists between members of a team of professionals providing health care to patients, the breakdowns in communication and collaboration can have devastating effects. Finding ways to prevent or manage conflict is essential for all individuals involved in interprofessional teams, from managers to administrators to the individual professionals themselves. This study investigated the use of a micronegotiation technique (Rogers & Lingard, 2006) intended for use by surgeons in managing operating room conflict. The research looked at the effect of the technique on task conflict, relationship conflict, team performance and team member satisfaction on teams of undergraduate health profession students.

The literature review was completed using two methods. First, searches were conducted in EBSCOhost and PubMed using key words such as conflict, medical conflict, negotiations, medical errors, and medical conflict resolution. Those searches were delimited to years 1990 to present. The second method was reverse tracking of relevant articles using the reference list. In this method, reference lists in specifically relevant articles were reviewed and sources from the reference list then investigated.

The literature review suggests that there appears to be evidence of the negative impact of conflict on medical outcomes. Baldwin and Daugherty (2008) surveyed medical residents and found that those who reported experiencing higher rates of conflict with colleagues also reported higher rates of significant medical errors (SME) and adverse patient outcomes (APO). Higher rates of committing medical errors was also related to higher rates of residents reporting being humiliated or belittled. Baldwin and Daugherty (2008) found:

Of the 2,811 residents who reported having no interprofessional conflict, 669, or 23.8% reported making a SME, with 3.4% APOs. By contrast, the 529 residents who admitted serious conflict with at least one other professional reported a total of 36.4% SMEs and 8.3% APOs. For the 193 reporting conflict with two or more other professional groups, the SME rate was 50.5% and 16% APOs. (p. 581) Conflict comes with high social and economic costs. In medicine, the Institute of Medicine's (IOM) report To Err is Human (1999) stated that between 44,000-98,000 individuals died in hospitals each year as a result of medical errors and that these errors cost between $17 billion to $29 billion a year. The IOM indicated that "faulty systems, processes and conditions" were primary contributors to these medical errors (1999, p. 2) with communication and interaction of medical personnel being among the faulty systems. The Society of Actuaries (2010) determined that $1.1 billion was spent on short-term disability claims, and over 10 million excess days of work were missed as a result of medical errors. This expands the breadth of economic impact beyond only the organizational level to national and even international level given the context of the global marketplace. When considering Swanson's (1995) business perceptions of human resource development, addressing conflict and its effect would certainly seem to qualify as "a major business process, something an organization must do to succeed" (p. 207).

One of many accelerants for conflict within healthcare teams may be the conflict style employed by various parties. For example, Skjorshammer (2001) found that forcing and avoidance were the primary styles used by physicians in his study of conflict in Norway hospitals. This is not to suggest that the use of either the forcing or avoidance style is always inappropriate, but if a conflict is consistently not addressed or repeatedly shut down by one party through an exercise of power, it can have lasting effects on individuals' ability to collaborate effectively. In a medical setting, this may lead to less than optimal patient care (Baggs Schmitt, Mushlin, Mitchell, Eldredge, Oakes, & Hutson, 1999).

Medical environments are unique and as such require contextualized consideration for when teaching conflict management skills to healthcare professionals (Kaufman, 2011). Investigations on various methods for managing conflict and increasing collaboration and understanding among interprofessional teams are ongoing and necessary. One such method is the use of Interprofessional Education (IPE). There appears to be some evidence regarding the benefits of IPE for providers and patients (Carpenter, Barnes, Dickinson, & Wooff, 2006). As the use of IPE has increased, studies have focused on appropriate learning outcome expectations (Thistlethwaite & Moran, 2010) and ways to measure IPE's effect on participants (Thannhauser, Russell-Mayhew, & Scott, 2010).

Others tools, such as Crew Resource Management, have also been applied to medical and interprofessional teams to increase communication and collaboration (France, Stiles, Gaffney, Seddon, Grogan, Nixon, & Speroff, 2005; Haller et al., 2008; Lerner, Magrane, & Friedman, 2009; Mcgreevy, Otten, Poggi, Robinson, Castaneda, & Wade, 2006). Additionally, training on conflict and conflict resolution skills for medical personnel has also shown promising results in participant perceptions of conflict and behavioral change in reacting to conflict (Brinkert, 2011; Haraway & Haraway, 2005; Saulo & Wagener, 2000; Zweibel Goldstein, Manwaring, & Marks, 2008).

This study investigated the effect of teaching team leaders on the use of a micronegotiation technique as introduced by Rogers and Lingard (2006). The technique was recommended for use by surgeons for managing conflict within the operating room and addresses the issue of communication and active listening that are essential to resolving conflict (Back & Arnold, 2005; Gill, 1995). Rogers and Lingard (2006) recommended the following:

Practice expedited negotiation as a conflict response process. Developing a pattern of this type of problem solving allows it to become a style. This "micronegotiation" should take less than a minute but consists of the following steps found in formal negotiation: Take a few seconds to allow for the control of emotions in a tense clinical situation, particularly if conflict has already occurred. Listen to the ideas or concerns of the other party and paraphrase or summarize them to indicate that they were heard. State your primary need or interest. It might be possible to suggest a solution, but it is important to indicate that there might be other reasonable options. Allow the other individual to react and express a respect for his position. Decide which conflict response will now be optimal. Problem solving is preferred whenever possible. (p. 572) Before providing a description of the methodology for this study one point stands out that is worth discussing. The final sentence directs the leader to choose an optimal conflict response. This suggests that the technique may be less a conflict resolution technique and more a conflict resolution assessment technique, as it directs the user to gather information and then select the appropriate response. The difference is worth noting, but the benefit of the system comes in its ability to move the user into a collaborative mindset, rather than settling on avoidance or forcing, which Skjorshammer (2001) saw in his study. This will be discussed further in the discussion section.

METHODOLOGY

The effect of training on the micronegotiation technique was measured on levels of task conflict and relationship conflict as defined by Jehn (1994), as well as satisfaction and team performance, using a pre- and post-test design. Four research questions served to guide this study:

R1 What effect does training on the micronegotiation technique have on task conflict in teams of health profession students?

R2 What effect does training on the micronegotiation technique have on relationship conflict in teams of health profession...

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