Dysfunctional Teams
Instructor Name
Learning Objectives
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Describe types of conflict and various
management approaches
Use a basic framework to problem-solve
Develop techniques to assist a difficult
team member
Conflict
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No one likes it
Adds to stress
Can destroy team dynamics
Can influence career goals
Can influence personal life
Some Conflict is Good
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Leading cause of business failure
among major corporations → Too much
agreement among top management”
Lack of tension → Complacency
Essential, ubiquitous part of
organizations
Reflection
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Reflect on a time when you had conflict
w/ a person (or a team) that didn’t
function well
Describe it
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What was the problem?
How did you handle it?
Types of Conflict
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Issues
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Decision-making
Topic-oriented
People
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Emotional
Feeling of resentment
Relationships
Conflict Management Approaches
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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
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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
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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,
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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!
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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
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Establish common goals
Separate the people from the problem
Avoid making conclusions or judgments
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Encourage 2-way discussion
Objective criteria to measure outcome
Establish Common Goals
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Focus on what both parties share in
common
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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
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Depersonalize the situation
Make the issue the behavior not the
person
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People get less defensive
Easier to resolve conflict
XYZ Approach
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When you (behavior), then
(consequences), and I feel (feeling)…
XYZ Approach
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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
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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
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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
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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:
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You are lazy!
You are wrong!
You are mean!
Make It a 2-way Conversation
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Do say:
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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
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Keep your opening statement brief
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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
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Clarify, ask questions
This is important for both of us
Objective Criteria to Measure
Outcome
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How will you know if your conversation
worked?
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How can we evaluate our plan?
Keep track of a measure?
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Number of interruptions, hours on rounds
Less tantrums
Let’s try it, and in 2 days sit down and
reassess
Be Nice
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Agree with something (if you can)
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Yes, it’s stressful worrying about
fellowship.
I remember getting annoyed with so many
pages, especially when many weren’t
important, but …
Be Nice
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Approach multiple problems
incrementally
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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
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Using your earlier example
Working in pairs or a group
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How could you have handled your situation
better?
General Framework for
Collaborative Problem Solving
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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?
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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
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Interpersonal skills involve 2-people
What to Do
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Become better acquainted w/ learner
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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
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Stressed
Sick
Poor coping skills
Frustrated with a
lack of support
Feel vulnerable
Feel scared
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Family situation
Drugs, alcohol
Financial strain
Tired
May not know any
better
…
Categories
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Capacity
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Lack physical / mental capacity to cope
Cognitively inadequate or unable
Personality traits
Motivation
Distractions
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Outside work (domestic, financial)
Appear disorganized, can’t make decisions, make
mistakes
Specific Behaviors &
Suggestions to Consider
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Slow
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Poor knowledge or skills
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Familiarize learner w/ time expectations
References, suggestions, give extra time
Fear of failure
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Provide expectations & feedback
“Mistakes are expected”
“Think out loud to help me better
understand your reasoning”
Specific Behaviors
&Suggestions to Consider
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Poor interactions, interpersonal skills
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Make sure he/she understands how others
perceive his/her actions
XYZ Approach works well here
Unmotivated - Most difficult
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Provide clear expectations
Change the behavior, not the personality
Grade accurately
For the Biggest Problems
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Don’t be afraid to involve the clerkship
or program directors
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We all have a vested interest
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Medicine is a profession
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Keep it that way
General Framework for
Collaborative Problem Solving
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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
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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???