Maintaining Calm In The Sea Of
Change
Martha Griffis, RN, BSN, OCN
Rita Suiter, Customer Service Coach
South Georgia Medical Center
Examples Of Things That
“Stress Us Out”
ENVIRONMENT
• EMR
• New equipment
• Construction
• Policy changes/JCAHO
• Traffic/Parking
• Healthcare climate
– Cutbacks
– Reimbursement issues
RELATIONSHIPS
• Children/Family issues
• Coworkers
• Patients
• Doctor relationships
• “Walk-ins”- (unexpected
customers)
• Schedule changes
• Conflict
USA Is A Stressful Nation!
• 93% of worksite accidents are the result of human
error (National Safety Council)
• 47% of US executives surveyed in 2003 didn’t use
their vacation time due to job pressures
• Up to 60% of all absences are caused by stress
• 72% of US workers report emotional stress is
pervasive in the workplace
• More heart attacks occur on Monday mornings
than any other day of the week
©2006 Wellness Councils of America
How Would You Define Stress?
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A loss of emotional control
The inability to cope with problems
Wear and tear on the body
The absence of inner peace
Changes that alter our routine – stress and
change are often used to describe the same
situation
Two Kinds Of Stress
Good Stress – Eustress
• Joy
• Happiness
• Euphoria
• Falling in love
Two Kinds Of Stress
Bad Stress – Distress
• Anger
• Fear
• Impatience
• Frustration
• Rage
• Embarrassment
Two Kinds Of “Distress”
• Acute Distress – Lasts About 20
Minutes
– Speeding ticket
– Run your boat into an iceberg
Two Kinds Of “Distress”
• Chronic Distress – Not nearly as intense
but lasts for days, weeks, months
– Job
– Financial
– Marriage
– Chronic pain
“The Chinese symbol for conflict or
change is the yin/yang. It means
opportunity riding a dangerous
wind.”
-- Denis Whatley
The Personal Definition Of Stress
The “perceived” threat (real or imagined) to one’s
mind, body, spirit, or emotional state
“I’m an old man now,
and IWhat
have known
a great Stressors?
many problems
Are YOUR
in my life…
most of which never happened.”
— Mark Twain
The Fight Or Flight Response
• This is the survival dynamic for physical
stressors…or physical response to danger
• Everyone has the fight or flight response
• Women also have what is known as the
“tend and befriend” response, a more
nurturing response to stress
The Fight or Flight
Response
Today, the fight or flight response is used primarily (and
inappropriately) for non-physical stressors, and herein
lies the problem: a stress-hormone cocktail that wrecks
havoc on the body under repeated bouts of chronic stress
©2006 Wellness Councils of America
Short Term Effects Of Stress
Physiology
Stress hormones released during the fight or
flight response:
• Epinephrine
• Nor-epinepherine
• Vasopressin
• Aldosterone
• Cortisol
This Stress Cocktail Causes
Increased:
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Heart rate
Blood pressure
Breathing pattern
Muscle tension
Perspiration
Metabolic activity
Long-term Effects Of Stress
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Hypertension
Chronic pain
Muscle tension
Depressed immune
system
• Increase in colds and
flu
• Fatigue
• Insomnia
• Depression
Stress and Disease
• 80% of visits to primary care physicians are
related to stress
“Ultimately the body becomes
• The relationship between stress and disease
the
battlefield
for
the
war
games
is no longer thought to be associated, but a
direct link of the mind.”
—Brian Luke Seaward, Ph.D.
Fear And Anger
• Fear is the flight
response
• Anger is the fight
response
• Left unresolved, fear
and anger become
control issues
Fear And Anger
Left unresolved, these
emotions may result in
chronic health issues:
• Lupus
• TMJ
• Headaches
• Fibromyalgia
What Do Frasier’s Dad And Change
Have In Common?
• Change is NOT comfortable!
• Staff satisfaction is disrupted
• Frustration builds during
adaptation
• Positive attitudes are contagious
while negative attitudes are
infectious
Culture Change Involves Knowledge!
Knowledge management will not be effectively
implemented without a culture of collaboration,
trust, and mutual respect among the staff
Avoid being:
• “out for the individual” – look for the good of the
team
• Controlling about your job knowledge – share
what you know and we all win!
Fear and Anger Can Lead To Conflict
Thought For The Day
Customers may
come and go
Co-workers stay
longer!
What Is Conflict?
• Conflict occurs when there is a difference of
opinion
• Conflict is natural
• Conflict does not have to be personal
• Conflict can be constructive OR destructive
Workplace Conflicts Are…
About
understanding
differences
An opportunity to build
positive relations
Distinguishing Between Two Types
of Conflict
• The issue
• The way conflicts
are being
managed
Three Different Approaches:
• Aggressive – direct/controlling
– Escalates conflict
• Passive – indirect/submissive
– Passes the buck/finger pointing
• Assertive – direct / working together
– Resolves Conflict
Four Conflict Traps:
• Fighting for the last word
• Saying things are resolved when they
are not
• Dismissing the issue completely
• Serving up “put-downs”
Competitive Climate
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Mistrust
Suspicion
Self-interests
Lack of team spirit
Basic Human Nature:
“In any controversy, the instant we feel anger,
we have already ceased striving for truth,
and have begun striving for ourselves. Men
are not AGAINST you…they are merely for
themselves.” --Unknown
Competitive Results
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Flow of information and resources halted
Unproductive conflict
Productivity is deterred
Increases stress
Decreased morale
Harsh confrontations
Conflict Is Destructive When:
• The problem is not resolved
• It drains energy from more important
issues
• It destroys the team spirit
• The team or individuals become
divided
Cooperative Climate
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Trust
Information sharing
Exchange of resources
Risk and efforts
supported
• Team spirit
Cooperative Results
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Conflicts are managed productively
Higher productivity
Higher quality
Reduced stress
Strengthened working relationships
Collaboration
Freedom of expression
Exploration of alternatives, creativity, and
confidence
Conflict Is Constructive When:
• People grow and
change positively from
the experience
• The conflict provides a
win-win situation
• Involvement is
increased for everyone
affected by the conflict
• Team cohesiveness is
increased
Planning
For Conflict Resolution
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Choose the time and place carefully
Change behavior– not people
Agree on something
Use “I” language
Figure out your part in the conflict
Planning
For Conflict Resolution
• Criticize concretely – be specific!
• If emotions run high – bow out for
a while
• Find the win-win solution
When You Are the Most
Anxious..Remember the Three C’s
• Remain
Confident
• Calm
• In Control
Action Guides For Conflict
Management
• Take the first steps
• Check your
assumptions
• Deal with negative
attitudes
• Remain open-minded
• Focus on working
together
• Discuss cost of
destructive conflict
• Avoid blaming
• Demonstrate
understanding
• Change your behavior
• Prepare alternatives
Pitfalls To Avoid:
DON’T ASSUME:
• Discussing conflict
will escalate the
problem
• You alone must
change
• Your opponent alone
must change
Pitfalls To Avoid:
DON’T:
• Believe that your
challenger WANTS to
be frustrating and
difficult
• Wait for the other to
make the first move
Make Sure That You Do:
• Keep arguments
rational and task
oriented
• Believe that conflict
can be resolved with
positive results!
Conflict Summary:
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Put problem people in proper perspective
Take your pick: positive or negative
Don't expect difficult people to change
Learn to respond as well as listen
Give and request frequent feedback
"There are two primary choices in life: to
accept conditions as they exist, or accept the
responsibility for changing them."
--Denis Waitley
Reduce Conflict And Stress
• Recognize the signs of stress
– Physical, mental, emotional
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Keep a positive but realistic attitude
Develop time management skills
Learn to communicate well
Take good care of yourself
Reduce alcohol intake instead of escalating
Reduce Conflict And Stress
• Become more spiritual
– Be in tune with yourself
– Take time out for me
– Seek to read articles and books that “feed your
soul”
– Make less lists and pay more attention to the
life we have “in the moment”
Become Fully Engaged In Living
“…we need to wonder how we lost touch with
ourselves and with the fundamental
breathing rhythm of the cosmos. How have
we forgotten the rhythms of day and night,
new and full moon, spring and fall, in breath
and out breath? How might we regain our
living, pulsing, embodied place within the
greatness of nature?” Jacob Needleman
Stress Reduction Exercises:
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Regular exercise reduces stress
Deep breathing exercises
Yoga
Tai-Chi
Guided imagery
“I cannot and should not be cured of
my stress, but merely taught to enjoy it.”
—Hans Selye
©2006 Wellness Councils of America