Giving feedback in the midst of conflict.

Conflict is a normal and steady component of daily living. There are always choices, and one person's choices may not, indeed seldom do, coincide neatly and exactly with those of others. There are, of course, varying levels of conflict, but no person can expect to travel through even a day without encountering some conflict. The key to success, and to conflict resolution, is dealing with conflict at, or near, its point of occurrence.

Conflict is personal. What causes it for one person doesn't cause it for another. But no matter how mature you are or how well developed your interpersonal communication skills are, when conflict appears on the horizon, your first primitive internal reaction will most likely be-"There's a sabertooth tiger. Let's fight or let's run." Flight or fight syndrome. In your head, you probably decided which you would do. When conflict occurs suddenly, you will feel the heat of blood and adrenalin rushing through your body. You have an established pattern for how to deal with danger.

If your first reaction is fight, you probably say what you think and feel immediately. Sometimes it's appropriate, but sometimes it's not and you have mop-up work to do-go back and apologize, try to fix it.

Those who flee or who mentally check out avoid an immediate unpleasant scene, but sometimes they are putting off the inevitable. They may delay saying anything and continue to put up with bad treatment. One day they may absolutely explode and also have mop-up work to do.

Fight or flight is a normal reaction. We prefer talking about people who aggravate us over telling them what we don't like. We feel superior to the offender. In confrontation, we could get hurt. Neither fight nor flight is a very effective response.

I will discuss two ways to deal with conflict:

* When you suddenly find yourself in a situation where conflict is thrust upon you.

* When you have time to prepare for a difficult encounter.

Sudden Conflict

If someone is suddenly screaming at you, what can you do?

1. Breathe deeply.

2. Ask questions to get information-"What do yowish I had done?" "Other useful replies to hostile criticism are: `I don't blame you for the way you feel, I should have thought of that' or `I'm glad you brought this matter to my attention; how do you think it should he handled?"[1] I expect some readers are thinking-"[1] would never say such a thing. Remember. in this particular situation, I'm assuming you do not want to escalate the emotional heat.

3. Don't yell or attack orally.

4. Don't cry. (Most people who have been through medical training have had the tendency to cry conditioned out of them.)

5. Say, "Can I think about this a while and get back to you?" if it is your boss. "I need to think about this and get back to you," if it is a peer or subordinate.

There are times when it is appropriate to get angry quickly or to cry, but you want to limit those times, particularly in the work place. John Gray of the much read Men Are From Mars, Women Are From Venus poses theories about why some people often display play anger or tears. "People who get angry easily generally are trying ing to hide from their hurt, sadness, fear, or regret. When they feel their more vulnerable feelings, the anger goes away and the become more loving. People who cry easily generally have a har time getting angry, but when they are helped to express anger, the feel much better and more loving."[2]

If you have a choice when someone makes you angry, wait until the next day to talk to them about it. You will be calmer. Try not cry, because many people in the workplace will discount your ideas if tears accompany them.

Preparing for Conflict

When you have time to prepare before conflict, decide what kind of feedback you want to give. I've numbered the 1st, 5th, and recommended steps, because I think that is the most effective order for those items. You will pick and choose the other items, when you use them, and in what order you use them.

Confront in stages. Start out gentle and move to tough. Don't use big guns if you don't have to. When giving feedback:

1. Be descriptive rather than judgmental. "Your postoperative infection rate is trending upward" is descriptive. "You are a sloppy surgeon" is judgmental.[3] If you want to keep things calm, stay objective.

Other examples:

"You interrupted me in the meeting, and I was unable to finish telling my idea," not "You are a pain in the ____ in meetings"[3] or "You like to hear yourself talk."

"We've had six complaints from your patients this quarter about lateness in starting your first morning appointment,"[3] not "You are inconsiderate."

"You are finishing my sentences for me," not "You're being rude" or "You're trying to control the conversation."

"Your nonsteroidal prescription rate is 3 times our benchmark level," not "You're an overprescriber."[3]

"Just now, when we were deciding the issue, you did not listen to what others said, and I felt forced to accept your arguments or to face attack from you,"[3] not "You are domineering."

"We were missing 10 items that we needed at the program," not "You are careless and sloppy when you pack for programs."

"Just now, when I told you I could get the materials to you a month in advance, you hesitated and said, `Well, I guess that's okay,"' not "You are never satisfied."

2. Place the feedback in the context of expectations.

"I see you are coaching little league again. The more visible we are in the community the better it is for our group."[3]

"The emergency department said it has not been able to reach you at night three times in the past month. We have said our doctors will see emergency admissions within two hours."

3. Talk about feelings-your own or make guesses about the other person's feelings. The many adjectives for feelings are usually some version of four categories-mad, sad, glad, afraid.

"I am annoyed." "You seem dissatisfied." "You seem upset, angry." "You've said yes, but you don't look as if you mean it."

4. Ask questions to understand the why of the behavior

"Can you tell me what you had in mind when you did that?" (in the right tone of voice-gentle inquiry), not "What on earth were you thinking when you did that?"

5. Ask, "What do you plan to do to change?" He or she might respond, "I get excited about a new idea and blurt it out. I will try to do better. If I interrupt you, will you say to me, `Let me finish.'"

6. Decide what you will do if the person does not change. Don't use this early in the conversation, but know what you plan to do before you have the encounter. If the person pushes you or if he or she does not respond to you in any acceptable way, tell him or her what you will do. If the answer is that you will do nothing, don't keep asking them to change. Every time you do, you lose self-esteem. If you have repeatedly asked someone to put out the garbage and they don't do it, stop asking. Do something else. Stop doing something for them that you now do. One time in my family, when no one would help me out, I stopped cooking. I got everyone' s attention.

Chuck Dwyer discusses feel good behavior and effective behavior in his book The Shifting Sources of Power and Influence. "We would love to believe that effective behaviors feel good, but very often the truth is they have costs and risks associated with them."[4] Effective communication often is not feel-good behavior. It feels good to yell if you're prone to fighting, and it feels good to withdraw if you're prone to fleeing. Neither are very effective. Talking to someone in a calm, firm, confident tone of voice in the midst of conflict is much more effective. If you are involved in conflict, it is unlikely to get better if you just keep thinking, saying, and doing the same old things. Try something new.

References

[1.] Layden, M. "Managing Hostility." Medical Group Management Journal 31(4): 50-6, July-Aug. 1984. [2.] Gray, J. Men Are From Mars, Women Are From Venus. New York, N.Y.: HarperCollins Publishers, 1992, p. 234. [3.] Howard Kirz, MD, MBA, FACPE. Executive Director, Northwest Center for Medical Management, Interview, Oct. 1993. [4.] Dywer, C. The Shifting Sources of Power and Influence. Tampa, Fla.: American College of Physician Executives, 1991, p. 67.