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Conflict Management Leads to Staff Retention

Training program improves the OR work environment

Monday December 4, 2006
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Interpersonal and interdepartmental conflict over anything from daily assignments and scheduling issues to equipment can happen at any hospital. The trick to making sure conflict doesn’t cause the work environment to crumble is to have a plan for conflict resolution.

The staff at Loyola University Medical Center (LUMC), Maywood, Ill., have built skills in managing conflicts through a video and training program developed by operating room (OR) leaders at the hospital. Since the program has been offered, staff members are resolving more problems themselves and are less likely to ask for help on interpersonal issues.

The video and training program is part of a recruitment and retention plan at LUMC, which began in 2004, that has made a difference in staff turnover and use of agency personnel. Historically, Loyola’s OR has experienced high staff turnover, averaging 21%. In December 2004, the OR management team partnered with the organizational development department to address the problem. A series of surveys and interviews uncovered the staff’s need for better communication and conflict management skills.

The program’s impact has been dramatic. Turnover decreased from 21% in December 2004 to 7% in fiscal year 2006, and vacancy and agency use is down to zero.

As skilled as the OR leaders were, many had not had formal leadership training prior to implementation of the conflict management plan. That changed when team leaders and management began attending the “Oz Principle” training, in which participants learned to increase personal accountability, responsibility, and ownership for achieving results. The leadership team also took part in coaching sessions and leadership courses that focused on techniques for increasing personal effectiveness, the basics of managing and leading staff members on a day-to-day basis, and skills for building strong work groups and committees.

Several programs and activities were also developed to improve team relationships in the department. First, employees developed ground rules that set a foundation for teamwork. The ground rules specified how team members will act toward each other and as a team. Sessions were also held to encourage staff to address their peers in a respectful manner when they perceive a violation of a ground rule. A peer recognition program was also developed in which staff formally showed appreciation for coworkers.

“Using ground rules and conflict resolution skills has improved my team’s communication by reducing gossiping and keeping us focused on working together in a positive manner,” says Lorinda Frascona, RN, neuro team leader. “The ground rules have served as guidelines for resolving conflicts, and we now encourage each other to talk directly to one another, instead of allowing an unresolved conflict to fester.”

Next, a “learning map” was implemented in June 2005, which tied employee opinion survey results to retention. Team leaders also held inservices in an effort to assist staff of different generations to work more effectively with each other.

“Staff morale has increased significantly since the commencement of these programs,” says Julia Leeberg, RN, staff nurse at LUMC. “The atmosphere within the OR has greatly improved, and I can honestly say that I enjoy my coworkers and my job.”

Programs were also developed for new employees, including a mentoring program, “Managing Conflict in the OR” training, and post-orientation focus groups. In the mentoring program, which started in August 2005, mentors meet with new employees for 12 structured sessions to improve the employee’s integration into the organization.

Training during orientation includes viewing a video with OR-specific scenarios that teaches new staff what to do in a conflict with a peer or a physician.

Finally, representatives from the organizational development department hold confidential post-orientation focus groups in which employees discuss what went well during orientation and what they recommend changing.

“Being a new nurse in the OR is filled with conflict and many stressful demands,” says Sara Barnes, RN, a staff nurse at LUMC. “Learning how to communicate with my peers has created a common ground for open discussions. The ground rules make it safe to resolve conflict.”

Staff and leadership development is a dynamic and ongoing process. Managers and team leaders also attend training that focuses on skills for talking when stakes are high, emotions are strong, and opinions vary. This way, the fire is doused before a situation burns out of control.

To purchase the video program, contact Mark Cerkvenik, MBA, OD specialist, at MCerkvenik@lumc.edu.

Jo Quetsch, RN, MA-OM; Margarette Kim, RN, CNOR; and Mark Cerkvenik, MBA-OD specialist, work at Loyola University Medical Center. To comment on this article, e-mail jspillane@nursingspectrum.com.

Conflict scenarios show different routes for resolution

Scenario #1: Susan, a new RN, and Connie, a veteran RN, are busy preparing for their next surgical procedure. Connie asks Susan what equipment she has gathered for the pending procedure. Susan begins to answer her question when Connie stops her and says, in a loud and condescending tone, “We went over this before. You must have a large abdominal retractor,” and immediately leaves the room. Susan is bewildered and hurt by Connie’s reaction. How would your staff handle this situation?

Possible positive outcome: In this example, the nurses could resolve the conflict using the “ladder of inference,” a communication technique that the Loyola University Medical Center staff is taught to assist with resolving conflicts.

Susan can say, “Connie, thank you for bringing this equipment problem to my attention. I will make sure we have the correct instruments, but I feel belittled when you use a tone like that. Please don’t talk to me like that.” Connie apologizes and explains her attitude, saying she was feeling rushed. Susan acknowledges Connie’s apology.

Scenario #2: Susan, Connie, and Dr. Jones are in the middle of a procedure when Susan hands Dr. Jones the wrong instrument. He shouts, “No, don’t be stupid; give me a rib spreader!” Susan and Connie are both uncomfortable.

Possible positive outcome: Susan hands Dr. Jones the correct instrument and states, “Dr. Jones, I apologize because I did make a mistake, but it didn’t warrant my being called stupid.” Dr. Jones answers, “Susan, I am sorry for what I said. I overreacted.” Susan accepts the apology.