Conflict management in the
pharmacy: adequately preparing
the pharmacy intern
Jeffrey Copeland, Pharm.D.
Regina Tabor, R.Ph.
Nicole Farrell, Pharm.D.
UIW FSOP
Oct. 3, 2014
http://holykaw.alltop.com/how-to-resolve-conflict
http://www.therealcenter.org/TheMagicOfConflict.php
http://www.hattoss.com/career/2012/06/18/how-to-dealwith-personality-conflicts-at-work/
Disclaimer
• Dr. Copeland, Ms. Tabor and Dr. Farrell do not have a vested
interest in or affiliation with any corporate organization offering
financial support or grant monies for this continuing education
program, or any affiliation with an organization whose philosophy
could potentially bias the presentation
Learning Objectives
• At the completion of this program, the participant will be able to:
1. Explain the importance of preparing a pharmacy intern for conflict
management.
2. Assess your own conflict management style using the “Conflict
Management Tool”.
3. Identify ways to incorporate conflict management learning activities
into an experiential rotation.
Conflict Management: Importance
Conflict Defined
• Interpersonal conflict: whenever two or more
individuals interact and disagree
• Subject matter
• Intellectual
• Moral
• Emotional component
Porter-O’Grady T. Embracing conflict: Building a Healthy Community. Health Care Management Review.
2004;29(3): Article 181-187
Berger BA. Conflict Management. In: Communication Skills for Pharmacists. 2nd edition. Washington,
D.C. American Pharmacists Association.. 2005. 97-105.
Why does conflict arise?
• Differences in:
• Values, personal attributes, perspectives, biases, roles, goals
• Miscommunication
• Scarcity of resources
• Dependence
Can you think of other reasons conflicts arise that you
yourself may have witnessed or experienced?
Porter-O’Grady T. Embracing conflict: Building a Healthy Community. Health Care Management Review.
2004;29(3): Article 181-187
Berger BA. Conflict Management. In: Communication Skills for Pharmacists. 2nd edition. Washington,
D.C. American Pharmacists Association.. 2005. 97-105.
Why are conflict management skills essential?
• Conflict is always in our midst
• Expansion of interprofessional collaborative practice
• Unresolved conflict leads to
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Spontaneous combustion
Collateral damage
Physical manifestations
Toxic work environment
High turnover rate
http://www.mrmarchuk.com/my-mind/
Berger BA. Conflict Management. In: Communication Skills for Pharmacists. 2nd edition. Washington, D.C. American Pharmacists Association.. 2005. 97-105.
Thompson DC, Nuffer W, Brown K.
Characteristics Valued by the Pharmacy Practice
Community When Hiring a Recently Graduated
Pharmacist. Am J Pharm Educ. 2012;76(9):
Article 170.
What Holds Student Interns Back?
• Fear:
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•
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Losing the relationship
Being the object of anger
Being hurtful
Being perceived as bad
http://survivingchurch.org/2014/09/21/selling-fear/
Cloud H, Townsend J. The Talk Can Change Your Life. In: How to Have That Difficult Conversation
You’ve Been Avoiding. Grand Rapids, MI: Zondervan; 2005: 15-19.
Berger BA. Conflict Management. In: Communication Skills for Pharmacists. 2nd edition. Washington,
D.C. American Pharmacists Association.. 2005. 97-105.
Your Conflict Management Style
Using the pharmacy conflict management scale
The Conflict Management Scale
• Who: Zubin Austin, PhD and colleagues at the University of Toronto
school of pharmacy
• What:
• Developed and established the validity and reliability of a conflict management scale
specific to pharmacy practice and education
• 19-item inventory
• Goal: Promote self-reflection & self-awareness regarding individuals’ conflict
management styles
Austin Z, Gregory PA, Martin C. A Conflict Management Scale for Pharmacy. Am J Pharm Educ. 2009;73(7): Article 122.
Direct
Imposing
Settling
Principled
Pragmatic
Thwarting
Avoiding
Indirect
Austin Z, Gregory PA, Martin C. A Conflict Management Scale for Pharmacy. Am J Pharm Educ. 2009;73(7): Article 122.
Conflict Management Style
•
•
•
•
Direct
Imposing
Settling
Imposing
Settling
Thwarting
Avoiding
Pragmatic
Principled
Thwarting
Avoiding
Indirect
Austin Z, Gregory PA, Martin C. A Conflict Management Scale for Pharmacy. Am J Pharm Educ. 2009;73(7): Article 122.
Your Turn
• Complete:
• The Conflict Management Scale (CMS)
• Four questions on the back of the CMS
• Record:
• Dominant style: letter circled most frequently
• Secondary style: next most frequently circled letter
Austin Z, Gregory PA, Martin C. A Conflict Management Scale for Pharmacy. Am J Pharm Educ. 2009;73(7): Article 122.
Discussion: Four Questions
• In your day-to-day experience, what are some of the most common reasons
for conflict with other people?
• What strategies do you find effective in identifying whether a conflict is
serious or not?
• What tactics do you use to prevent a conflict from escalating further? What
tactics do you use to resolve a conflict?
• If someone were involved in a conflict with you, what tactics would be most
effective to use to “win you over”? What tactics would be less effective?
Austin Z, Gregory PA, Martin C. A Conflict Management Scale for Pharmacy. Am J Pharm Educ. 2009;73(7): Article 122.
Conflict Management
Training the Student Intern
UIW Curriculum: Conflict Management
• Pharmacy Communications
• P1 year Fall (2 credits)
• Conflict Management:
• Barriers I Lab: “assertive, aggressive, passive pharmacist”
• Barriers II Lab: “angry patient lab”
UIW Curriculum: Barriers I Lab
• Assertive communication:
• Stay calm
• Use of “I statements” (“I need”, “I feel”, “I deserve”).
• Example “Ms. X I would like to help you, but I need foul language to be avoided.
We each deserve respect.”
• Example “Mr. Y I can see you are frustrated, but I need a calm explanation as to
what went wrong. Why don’t we step over to the private consultation window and
discuss things further.”
Berger BA. Assertiveness. In: Communication Skills for Pharmacists. 2 nd edition. Washington, D.C.
American Pharmacists Association.. 2005. 87-95.
UIW Curriculum: Barriers I Lab
• Assertive communication:
• Broken record
• Example: “I cannot, in good conscience, fill this prescription as written.” (said
repeatedly)
• Fogging
• Example:
• Prescriber: That is stupid! Why do I have to fill out a prior authorization for the
medication?
• Pharmacist: I know this must be frustrating for you, but the insurance company will
not cover the cost of the prescription otherwise.
Berger BA. Assertiveness. In: Communication Skills for Pharmacists. 2 nd edition. Washington, D.C.
American Pharmacists Association.. 2005. 87-95.
UIW Curriculum: Barriers I Lab
• Assertive Communication:
• Sorting issues
• Example:
• Prescriber: I can’t understand why you would question my judgment on this
prescription. I thought we were friends.
• Pharmacist: I am your friend, but I’m also a pharmacist. I need to discuss this issue with
you as a pharmacist. As a pharmacist I feel that filling this prescription could cause Ms.
Jones to have an allergic reaction.
Berger BA. Assertiveness. In: Communication Skills for Pharmacists. 2nd edition. Washington, D.C.
American Pharmacists Association.. 2005. 87-95.
UIW Curriculum: Barriers II Lab
• Step # 1: Active listening (repeat as needed)
• Appropriate eye contact
• Full attention to patient
• Do not immediately try to jump in and fix the problem
• When the patient is finished talking summarize what you have heard and ask any
questions to further clarify their complaint (e.g. “ma’am or sir, please correct me if I am
mistaken, but what I hear you saying is…”
UIW Curriculum: Barriers II Lab
• Step # 2: Skills used to address an emotional response/disarm the anger
(allow the patient time to express their frustration and or concerns)
• Reflection: Ability to recognize someone’s emotional reactions and communicate
your understanding of these reactions
• Example: “You seem frustrated by having had the long wait in the doctor’s office.” “I
see that you are angry at me because you expected your medication to be ready” “I
realize you have a serious health condition and it needs to be treated.” “I understand
that your time is very valuable, and you seem angry that it is being taken for granted.”
• Legitimation: Express a sense of understandability of the patient’s emotion.
• Example: “I can certainly understand why you’d be upset. You came to me
looking to find a filled prescription. I do not have the medication you are looking
for. I might be upset also, if I were in your position.”
Cohen-Cole SA. The "Difficult" Medical Patient. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations.
3rd edition. Boston: Butterworths; 1990. Chapter 228. Available from: http://www.ncbi.nlm.nih.gov/books/NBK339/
UIW Curriculum: Barriers II Lab
• Step # 3: Provide a reasonable straightforward explanation at
this point of the problem:
• Example: “I do see that you are upset by the delay in getting your
prescription and I also want to make it perfectly clear to you that I
can understand why you’d be upset by the delay. Let me try to
explain to you the situation and see if it makes sense. The
shipment of the new drug did not come in last night to the
pharmacy as expected. I have called to put a rush on the order, but
I realize that it will not be in until tomorrow morning.”
Cohen-Cole SA. The "Difficult" Medical Patient. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations.
3rd edition. Boston: Butterworths; 1990. Chapter 228. Available from: http://www.ncbi.nlm.nih.gov/books/NBK339/
UIW Curriculum: Barriers II Lab
• Step # 4: Problem-Solving with participation
• Identify the problem
• Clarify the nature/effects of the problem (be specific)
• Clarify your desire for change
• Stay on task
• Identify all possible solutions & decide which is best
Cohen-Cole SA. The "Difficult" Medical Patient. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and
Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 228. Available from:
http://www.ncbi.nlm.nih.gov/books/NBK339/
Berger BA. Assertiveness. In: Communication Skills for Pharmacists. 2 nd edition.
Washington, D.C. American Pharmacists Association.. 2005. 87-95.
UIW Curriculum: Barriers II Lab
• Step # 4: Problem-Solving with participation
• Example: “After speaking with you about not having your medication in stock, I have
two options to offer you . Please let me know which you would prefer. I do value you
as a customer and would like to make things easier for you. If you would like we can
call the pharmacy down the road and have them fill the prescription and have it ready
for you to pick up or if you would rather we now have delivery service available in the
pharmacy and I can have the prescription delivered to your house tomorrow morning. ”
Cohen-Cole SA. The "Difficult" Medical Patient. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations.
3rd edition. Boston: Butterworths; 1990. Chapter 228. Available from: http://www.ncbi.nlm.nih.gov/books/NBK339/
UIW Curriculum: Barriers II Lab
• Step # 6: Conclude the session
• Always end positively
• Example: “I am sorry you feel that way. Here is your prescription back. Please let me know
if you would like me to assist you in any other way.”
• Step # 7: Step away and take some time to reflect on the situation
• Take a breather
• Quality/Assessment
• Follow-up:
Cohen-Cole SA. The "Difficult" Medical Patient. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The
History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 228. Available from:
http://www.ncbi.nlm.nih.gov/books/NBK339/
Berger BA. Assertiveness. In: Communication Skills for Pharmacists. 2nd edition. Washington, D.C. American
Pharmacists Association.. 2005. 87-95.
Conflict Management: Techniques
When to use
Skill
Example
To avoid conflict escalation
Paraphrasing and restating
“Dr. Z, you sound upset because I made
this recommendation to discontinue your
patient’s HCTZ.”
When the other party has a piece of truth
that needs to be acknowledged
Partial agreement without self-indictment
“You are right, there are some individuals
with reduced renal function who still might
benefit from HCTZ.”
Anger that comes your way that is overly
vague
Ask for specifics
“What is it about the recommendation that
upsets you?”
When the conflict is unfairly abusive and
even
Ownership of language and appropriately
assertive tone of message
“I am uncomfortable with your tone
regarding this situation without
understanding my reason for the
recommendation.”
If the conflict has heated up and emotions
are escalating
Contracting to talk at a later time
“I need some time to think about what you
said”
McDonough RP, Bennett MS.. Improving Communication Skills of Pharmacy Students Through Effective Precepting. Am J Pharm Educ. 2006;70(3): Article 58.
Conflict Management: Preceptor Role
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Reinforce UIW Curriculum
CMS
Model
Anecdotes
Role play
Coaching
Summary
• Importance of conflict management: Conflict is unavoidable, has negative
consequences if put off & conflict management skills are a valued asset to a health
care team
• Self reflection on using the Conflict Management Scale (CMS) allows an individual
to better understand how they address conflict
• Instruction in conflict management is an important role a preceptor takes on in
training a student intern:
• Examples: Modeling, role play, coaching, reiteration of UIW curricular teachings, selfreflection using the CMS
QUESTIONS?