And now I would like to introduce our speaker to get us started with this morning's presentation. Dr. Neal McIntyre is an expert who has worked with organizations to reduce toxicity, conflict and drama over the past 20 years. He uses his knowledge of human and organizational behavior to develop tactics and strategies to make health care a safer environment. Additionally, Dr. McIntyre develops high performing teams by facilitating productive conflict, de-escalation and removal of toxicity. We thank you so much for being here with us this morning, Dr. McIntyre. We invite you to go ahead and get us started with today's presentation. Thank you. Good morning, everybody. It's good to be here with you all this morning. First of all, before we get started, I would like to express my appreciation to Andy Cobb and Lindsay Cason and the Georgia Hospital Association for allowing me to have this opportunity. This is a very important topic that I know is timely. And it's talking about a concern that a lot of you are kind of experiencing and everything within health care. So I hope today that when we get finished with this, there will be a lot of things that you will take from this and be able to go back to your respective institution and be able to implement there. So anyway, as you said, I am an individual consultant who basically owns and operates the Center for Dispute Resolution, as well as Neal McIntyre Consulting. I have dealt with conflict for many years as far as individuals and organizations. So I'm kind of excited to talk about what has worked for me, what I have developed during that time period. So without anything else being said, let's get started. Now I'm having technical difficulties. You might be able to right click there and see where it says next slide. Where are you at? If you just right click on your screen. Okay. And then at the top where it says next. Okay. Okay. So I guess the initial question we have is why be concerned about this? I mean, you all live with this every single day. You hear the concerns from your frontline staff and others within the hospital environment. Well, if you look online and kind of look at news events, it won't take you very long to find different news reports highlighting violent situations within the health care sector. In matter of fact, when you start looking at that, you will quickly discover how health care has become one of the nation's most violent fields out there. That was really surprising to me when I first started looking at health care and what I could do to assist health care itself because knee jerk reaction. I kind of figured law enforcement would probably be the most violent field since they deal with criminals all the time and violent situations. But that's just not the case. And what I have here is just a few of the recent headlines over the past year or two. Now, of course, if you go online today, you'll see even more recent headlines. We just patents the need for us to be concerned in trying to find options to deescalate this situation before it gets out of hand, gets physical. And, of course, when that happens, of course, you have significant liability issues for the center itself. So when you look at conflict itself, it's not just limited to health care. Conflict is nationwide in every single business out there. This just kind of gives you an idea of how much businesses are being charged, basically, for conflict, how much they spend on conflict in each every year. There's estimates out there that we spend somewhere close to three hundred and sixty billion dollars a year dealing with conflict. Now that, as I said, is not just in health care, that's in businesses in general. That's also taking into consideration internal conflicts as well as external conflicts with customers, patients, clients or whoever. Now, when you kind of break that down even further, the average supervisor will generally spend about 20 to 40 percent of their time managing conflicts. That's a significant amount of time for managers to spend just dealing with that. If you talk about having a manager who's making a salary of fifty thousand dollars a year, basically what that equates to is that ten to twenty percent or ten thousand to twenty thousand dollars of their salary is basically devoted to time that they're dealing with conflict. So it's costing tremendous amounts of money there to deal with that. And it's a significant cost for organizations. So even if you look down even further to the average employee, it's basically calculated that the average employee spends about three hours per week dealing with conflict. Now, if you're talking about a fifteen dollar an hour employee, that will come up to two thousand one hundred eighty four dollars per year. That is basically spent with that employee dealing with conflict. Now, of course, if you have somebody that's making a salary, that's that's more than that. You know, your nurses may be making average twenty five to thirty dollars an hour. Doctors more than that. Still the same thing. Three hours a week. It adds up real quick. If you look at things, 65 percent of all employee performance problems are due to bad relationships, not bad employees. Now, when we talk about bad relationships, that could be relationships with our coworkers. It could also be relationships with the customers and stuff or the clients or the patients that they deal with. So it's not necessarily you have a performance issue with an employee. It's not necessarily they're a bad person or a bad employee. There's other factors that oftentimes are contributing to that. As far as OSHA recommendations, there has not been any actual mandates that OSHA has come up with so far to address the violent instances in health care. Now, we're saying that you do have some accrediting bodies like the Joint Commission that has come out and mandated requirements for annual conflict assessments or even de-escalation training for hospital staff. Now, what OSHA actually recommends, though, is that new and reassigned workers should always receive conflict de-escalation orientation before beginning their assigned job duties. And also that piggybacking on that, that every single year they should receive additional training on conflict de-escalation. Now, OSHA also recommends that if you have a high risk setting or institution, that the training may be necessary more frequently, whether that may be monthly, whether that may be quarterly, whatever. But in those high risk settings and institutions, having annual training may just not be enough. And there's also been some research out there that has suggested that if you have an individual that goes through training today and that's it, a lot of what they learn in that training about de-escalation is lost over the next few weeks and everything. So having follow up training to kind of drive in those skills and tactics really is beneficial. So when we look at conflict, what are we talking about when we talk about conflict? Well, in a nutshell, conflict is nothing more than a serious disagreement or argument that prohibits productivity. Now, that conflict can be a one time acute event or it could be a chronic and recurring situation. Of course, when we have these type of events happen in the workplace, it leads to damaged relationships, poor performance, and for hospitals and stuff, definitely poor patient care. For other businesses, it could be poor client and customer care. Now, with that being said, I've already alluded to this, that conflict can be internal between coworkers or different departments or supervisors and subordinates, but it can also be externals. One of the things that I encounter a lot is when I meet with executives, I know the main concern is with external conflict, and they basically say we don't really have internal conflict. As a matter of fact, I had one about a year ago that told me that in their organization, they don't have conflict internally. They're all like a big family, which is great. But with my dealing with conflict, where I have seen the ugliest conflicts at is usually within family units. Every organization has conflict, regardless whether it's internal or external, whether we want to admit it or whether we don't want to admit it. Conflict is always present. Now, on I guess the bright side of it, even though most conflict situations that we see are in the news because they are violent, because they are physical, when you really look at it and the statistics of it, 95% plus of conflict never resorts to physical violence. This is one of the reasons why non-physical de-escalation tactics are bodily important. This is what I really believe in, that when you have a potential violence situation that's unfolding, if we can be proactive on this, if we can give especially frontline workers the skills and the tactics to address these at the onset, we can basically de-escalate this before it blows up into something physical, before somebody gets hurt, before somebody gets killed. And that's why I think what we're covering today is extremely important. So when we look at the causes of conflicts, there's many different causes of it. This is just a few that I've listed here. Of course, causes of conflict can be unique to the individual. It could also be rooted into the organization, the practices, the procedures of the organization itself. Now, from an individual standpoint, this could be preconceived biases or assumptions that they have about certain groups or certain individuals, which if you have a preconceived bias or assumption, that clouds your interaction with other people from the start. It could be poor communication or a lack of communication or even miscommunication. You know, we all think that we communicate very effectively, but we all have room for improvement. Some of us are better communicators than others are. It can also be distractions or lack of attention. We have a huge problem with that in society now. You go out to eat somewhere and you just watch people. It's not uncommon to see a couple sitting at a table on the side of the room and instead of talking to each other, they're on their phones or one person may be talking while the other person's on the phone, and they're not giving full attention to that person. The same thing happens in the job place, too. Or it could be a situation where an individual has so many tasks that they're trying to get accomplished within a certain time period that they're really not thinking too much about what they're doing right now in the moment because they're already thinking about the next patient they've got to go deal with or they've got X amount of patients to check on and they're supposed to get off of work in 30 minutes. It can also be poor self-care. You know, we don't get the proper amount of rest or sleep or we have poor stress management. That basically clouds our judgment. It also shapes the way we interact with other individuals, and it can be a source of conflict itself. From the organizational side of things, conflict could be caused by unclear or impractical policies and procedures. You know, in a perfect world, sometimes our policies and procedures sound great in theory, but in application, they just really don't work correctly in the real world. So sometimes those unclear or impractical policies and procedures lead to conflict. It could also be unclear roles and or expectations, such as whose duty is it to do this? Whose job duty is it to do that? Or a person going into a job with a notion that this is what my supervisors expect of me, but yet the supervisors have a different expectation. It kind of goes back to miscommunication again. It could also be change. I mean, we're all creatures of habits. We generally do not like change. So anytime at your workplace you're in the process of implementing new technologies or processes, that's going to cause friction. It's going to cause people to get a little frustrated, and it's very easy for them to take that out on other individuals. And truthfully, conflict can sometimes be caused by difficult customers or personality classes or even differences of opinion. I mean, there are some people you deal with, whether it's customers, patients, clients, whoever, they're just difficult to deal with. They come across as being rough and, you know, just kind of disgruntled to start with, or maybe people that you're working with just may have a very bad personality that kind of clashes with yours, and those factors there can definitely cause conflict. So what are some organizational symptoms of conflict? This is just a list of a few. Of course, it's not comprehensive and including everything, but I think it does include a lot of the more common ones that we see, you know, strained or damaged work relationships, whether it's poor performance or productivity. In a hospital setting, of course, that poor performance is oftentimes equated to poor patient care and not giving that patient the attention that he or she deserves. It could also be hostilities towards others. And in the hospital environment, this hostility could be directed towards your coworkers because of frustrations that you may be experiencing with patients or your own family members or whoever. It could also be hostilities that you take out on the patients themselves. Absenteeism is a huge symptom as well, because if there's a lot of conflict on the job, people are generally conflict avoidant. And so we're going to do what we can to try to avoid it, even if that means calling in that we're sick when we're not really sick, or we may classify that as we need to take a mental health day kind of sort of. We also see instances of sabotage whenever you have conflict there where one individual may deliberately sabotage the work of somebody else, normally the person that's causing the conflict. Or, you know, in terms of patient care, it may be kind of undermining the treatment plan that the doctors may have the patient on. You also have ill feelings towards others and just being grouchy towards other people and hostile and very quickly becoming hostile with other people, whether it's coworkers, whether that is the patients and the customers that you serve. Another thing that conflict leads to, especially if it isn't addressed and it isn't resolved, is turnover. Right now, the health care system across the board is experiencing workforce issues, particularly a shortage of nursing staff and others. Some of that is going to be because of conflict. Some of them, especially with violence escalating, some are just going to be feeling that the job's not worth it anymore. This isn't what they signed up for. They signed up for a job where they could help people, and that was going to be their personal reward, that they're coming to somebody's aid in a time of sickness or injury. They didn't sign up for a chance to be assaulted or victimized or whatever. So for those individuals, they may feel they can find a job doing something else and be in a more safe environment. I think a statistic I read a little while back, I want to say, said that I think it was like 58% of workers have either changed jobs or are thinking about changing jobs because of unresolved conflict at the workplace. So that's a huge reason for people leaving. And lastly, and we hope this doesn't happen, but sometimes it does. It's inevitable in certain situations. You will have physical violence. I think that if you just let conflict fester and you don't resolve it, then, of course, the longer it's there, the more likely you are to have physical signs of violence there, whether it may be patients assaulting the nursing staff, whether it may be nursing staff assaulting the patients or co-workers or whoever or patients' families lashing out at the hospital workers as well. So what are some of the common methods of responding to conflict? This is just a few. There's a lot of other ones that we have in addition to this, but I think these are some of the more common ways that we respond to conflict. The first thing is, as I mentioned a few moments ago, we're generally conflict avoidant. We don't like dealing with conflict. We feel uneasy dealing with conflict. So a lot of times we try to ignore it and hoping that it'll just resolve itself or if we ignore it, it'll go away. That may happen every once in a while, but most times it doesn't. It just continues to grow and fester and get larger. Sometimes we rely on policy to resolve it, which this is kind of sort of taking a black or white stance to what is often a gray problem. Policy is great, and I'm a policy-oriented person, but there are some instances that conflict is caused by policy issues, and sometimes the way policy says we need to respond to it may actually escalate the situation and cause the conflict to even become more complex. It may also cause the person that we're dealing with, when we basically force policy on them, it may cause that individual or other individuals to become very, I don't know what the term is, it kind of left my head, but they just become agitated by that a little bit and disgruntled. Sometimes we retaliate against a person. We fight fire with fire, even though we're not supposed to retaliate on things, but that does happen. Sometimes we go to the rumor mill where we try to tell other people what's going on from our point of view because we are trying to build up a team of supporters to help support us while we demonize the other person. Sometimes we even dig our heels in and just don't budge. This is our stance. This is how we feel on it. This is what maybe what policy says. There's no negotiations here. This is what's going to happen. Take it or leave it. Lastly, as far as here on the slides, is that oftentimes, especially in hospitals, we rely on internal teams or security. Sometimes this may be through a show of force by basically having them present or them being armed and hoping that's going to deter any acts of hostility and violence and things of that nature. I know a lot of times when I'll reach out to hospitals and stuff, one of the first things they'll tell me in the context of conflict and workplace violence is that we have our own internal teams that handle that. We have our security, and they're doing a good job, all that kind of stuff. Here's the reality of all of these tactics listed on the screen. They don't work. Your internal conflict resolution team or your security team is great, but they can't be everywhere at one time. For that nurse who is in a room dealing with a patient who becomes hostile, your internal security team can't do anything about that until they arrive. In the meantime, as that patient is getting increasingly more hostile, what is that nurse supposed to do until your internal team responds? Think about this. In that moment, if you're that nurse and you're on the verge of being physically assaulted or you're in the process of being verbally assaulted, in that moment, minutes seem like hours. They just don't work. They're good for what they are, but they don't really deter hostilities there. What makes the following tactics that we're going to discuss in a few minutes different? Number one, they're practical. They're not theoretical. I have seen them work over and over again, time and time again in different situations. They're proven effective. I've been doing this for 20 something years, dealing with individuals who are very violent, who have violent tendencies and hostilities and things of that nature. I've been able to defuse conflict after conflict by utilizing these strategies to give you a backdrop of this and everything to demonstrate what I'm talking about here. Years ago, I did serve several years in law enforcement. Most of that time was dealt with dealing with state probation. My caseload when I was with state probation involved very violent offenders and sexual offenders. I basically had day-to-day contact with that population. I have probably had more contact with violent individuals than the average person will have in their entire lifetime. I have had to defuse situations with these individuals peacefully. Now, you may say, well, you had a gun on your side. Of course, you're going to listen to me. You got a court order or whatever. Sometimes when you're in the thick of things and you're in a hostile situation, the gun being present really does nothing to it. Having a court order really does nothing for the here and now. I can take them back to court, but it doesn't help the situation that I'm in. The other thing I want you to keep in mind, too, when we talk about the following tactics is I've never been a very large physically imposing person. I'm, I think, five foot eight. Back when I was in law enforcement, I may have weighed 145 pounds. Most of the people I came in contact with, either as a police officer or back with my probation caseload, most of them were a lot larger than me. I'm talking about 6'2", 6'3", maybe 240 pounds. They could physically pick me up with one hand and throw me. One of the things I had to learn really, really quickly is that I need to learn how to talk to people. I need to know how to de-escalate hostilities and lower the temperature of a situation that I'm in. What we're going to be talking about over the next several slides is going to basically be what I have learned through my experience. With that being said, the tactics that we're going to talk about, they're flexible. They can be used in a wide variety of situations. This isn't just simply tactics that can be used in health care or within hospitals. It can be used in other sectors as well, even though today we're going to be talking specifically about hospitals. They're responsive. An individual that has these tactics and has the knowledge of what to do and to utilize these techniques that we're going to talk about, they have the opportunity then to de-escalate the situation, hopefully before security needs to get there, or even if the probability of even calling security may even decrease for somebody utilizing these tactics. These tactics also resolve the source of conflict and not just the symptoms. They're non-physical. Thereby, they reduce liability because anytime you put your hands on somebody, liability goes up through the roof. Also, these tactics take into consideration the neuroscience of conflict that we'll talk about in just a minute. Talking about the neuroscience of conflict, I'm not going to go into a whole lot of detail in that. This kind of just scratches the surface of it, but basically when we talk about the neuroscience of conflict, we're talking about how we process things and how we respond to things. Normally, when we're in a calm state of mind, a lot of our behavior, a lot of our thoughts, and the way we perceive things basically comes from us utilizing our prefrontal cortex. It basically helps us regulate our thoughts and actions and controls our emotions. This is what allows us to respond logically to situations that are unfolding in front of us. The challenge with this is that when we are startled by something that just comes out of the blue and we're not expecting this, such as a hostile situation, such as a verbal assault by a patient or somebody else, it kind of shocks us out of thinking with the prefrontal cortex. What happens is that our amygdala kicks in. Our amygdala is that basic part of our brain. If you want to call it the wizard brain, it basically is focused on our survival and scanning around and trying to figure out what are the threats and what do we need to do to survive. The amygdala doesn't really negotiate logical reactions at all. The amygdala is basically associated with fear, our emotions, and things of that nature. When the amygdala is triggered by that all of a sudden, out of nowhere event of you being attacked, you being verbally assaulted or whatever, your prefrontal cortex more or less shuts down and now you're operating off of whatever your amygdala is basically leading you to do or say or whatever. It's what we call an amygdala hijack, where logical thinking goes out the door and now we just become responsive. In some instances, that is beneficial because our knee-jerk response sometimes may be critical for us to have survival, but sometimes in that process of our amygdala being hijacked, we just don't think properly. We may say some things that we don't mean. We may do some things that we didn't really intend to do. Think about it. If you've ever been angry with somebody, have you ever said something to the person you're in an argument with that usually as soon as you said it or after it's over with, you go back and say, I wish I didn't say that. I don't know why I said that. The reason you did that is because your amygdala was hijacked. The same thing happens in conflict. When the amygdala is hijacked, we do things and we say things that we don't really intend to do. In that moment when our amygdala is hijacked, what we're really trying to decide here for our survival is whether we're going to flee, whether we're going to stand and fight, or whether we're going to freeze. It's based on our amygdala's interpretation of what's going on around us. Whatever the amygdala is leading us to do, it's oftentimes not rational at all. That's why some people when they get angry or whatever, they just go off the deep end because they're thinking with their amygdala, not the prefrontal cortex. When you look at conflict, and I developed this model a few weeks back, that really dissects conflict into four different dimensions or four different categories, I guess you could say. I think most of the time, the way we try to resolve conflict, we basically focus on the physical. We're trying to get the person to stop yelling and screaming. We're trying to stop the person from acting aggressively, which is great, but conflict is more complex than that. By those four circles and the four categories there, you can't really resolve conflict if you're only addressing the physical aspects of it. You've got to address the other three components of it as well in order to resolve and de-escalate conflict. Strategy one, emotions. We oftentimes, when we have conflict with somebody, whether it's a patient, whether it's a coworker, whoever, we think that they intended this by their actions, or they intended that by what they said. Don't ever assume intent. We don't know what the other person is thinking. Even if they deliberately did something, we still really don't know what their intent was. There may be other factors that we're not aware of that may have led that person to do what he or she did, or led them to say what they said. Don't assume intent because that automatically makes you defensive, and the other person can sense your defensiveness, which then escalates the hostility in that situation. Demonstrate self-awareness. Understand how you're feeling in the moment, and not just understanding how you feel, but if you're feeling angry, or if I'm feeling a little agitated, that's great to know how you're feeling, but also examine in that moment, why am I feeling this way? What's leading to these emotions? It's also with self-awareness, it's being aware of what you're paying attention to. Sometimes we pay attention to somebody, but we're not really paying attention. We're thinking about other things, and we're not really hearing what they're saying. I mean, what they're saying is coming in our ear and going out the other, but it's not really sticking. So, we need to have self-awareness in that context as well. Never talk down to the person. Show them respect. Show them dignity, regardless of what they're doing. I mean, you can't help what they're doing, but you can't completely control how you react. One of the things I have basically been asked time and time again over the years, when I've talked to people about my time dealing with state probation, and particularly child molesters on my caseload, people have basically asked me time and time again, how could you treat that child molester as being a person? I mean, why didn't you talk down to them? Why didn't you treat them with disrespect and everything? And my comment has always been, you hate what they did. You hate their behaviors, but you treat the person with respect. And the same thing in a hostile situation. No matter what that other person is doing, treat them with respect. Don't talk down to them. Don't belittle them. Validate their concerns. And this requires active listening, which we'll talk about a little bit more in detail here shortly, but listen to their concerns. And sometimes they just want to be heard. So validate their concerns by telling them, listen, I understand why you feel that way. And if I was in your shoes, I would probably feel the same way too. Now, if that's not the case, don't say that to them and lie to them. But in some instances in that conflict, they may have valid concerns though. At the same time, be empathetic to them, that you understand why they feel the way they do in certain reactions and stuff. Be responsive, but not reactive. This kind of goes hand in hand with an exploit as far as calming the amygdala. As we said a while ago, when you have an amygdala hijacked, you're basically faced with three choices, fight, flight, or freeze. You're basically reacting to the situation. Don't react. Be responsive. Understand what the person's saying and what they're doing. Understand what your surrounding is and the environment that you're in and make an appropriate response to it. Don't give into the emotions and don't just knee jerk react to whatever they said. I didn't think about it, but I spoke before. I had a chance to think about what I was going to say or whatever. Don't do that. Calmly think about what you're doing. Also, in these situations, understand the causes of emotions. With that, Fisher and Shapiro in their book, Beyond Reason, Using Emotions As You Negotiate, they basically identified that when we get hostile and we start showing emotions, there's usually five core concerns that lead to those emotional responses. Those concerns are appreciation, affiliation, autonomy, status, and role. Whenever we feel that these concerns are not being taken into consideration or if the other person is ignoring these concerns that we may have, then we're going to get a little agitated with it. We're going to get frustrated, such as if the person isn't expressing appreciation for us in the regards of our thoughts and our feelings and our actions are being devalued. They're being basically discarded or basically being ignored. Or if affiliation is the issue and we're being treated as an adversary or kept at a distance, that also leads to us becoming defensive and a little hostile with the people that we feel is infringing on that. One of the large things out there is the sense of autonomy. We all want to have the freedom to make decisions for ourselves. That may especially be the case in healthcare where you have an illness, you have an injury. We want to have some say-so in the treatment plans and not just have a doctor or nurse come in and say, well, this is what we're going to do or this is your option. We got to do it. Let the patient be involved in it. Let them have say-so there. Let them know that their feelings of fear or confusion or whatever is important and that you value that and you want to resolve that as easily as you can anyway. Strategy two, mental. When you're dealing with somebody else, always be aware of their body language. Not only their body language, but be aware of your body language as well because if you look at it, I can't remember what the statistic is, but I think it's somewhere around about 85% of our communication with other people is basically through body language. I may be wrong with percentage, but it is a fairly high percentage there. Be aware of that because your body language and their body language can give you indications that things are about to get hostile. When you're talking to the person, ask probing questions. Make sure these probing questions are not accusing them of anything, but you're asking probing questions so you can understand things better so that you can get their point of view and that you can hopefully get them to clarify what it is that's bothering them or leading to them getting emotional. The other thing is focus on interest instead of positions. A lot of times in arguments and hostile situations, we focus on positions and those are really hard to de-escalate. If you have, for example, one person says, I want to do this. Another person says, I want to do that. You're going to have a hard time convincing those people to meet in the middle or even get one person to go along with the other side. What you need to do is start looking at those two sides and, okay, why does this person prefer this option and why does the other person prefer whatever their chosen option is, and then go from there to see how you can meet the interests of both individuals. Now, from a patient standpoint, patients have interest. Whether that interest may be, I've been in a hospital for several days. I'm ready to go home now. I'm tired of being here. I'm ready to go. I want to leave now. Even though their underlying interest may still be, they want to get better because they don't want to come back. There's always some underlying interest there that oftentimes is overshadowed by the position that we oftentimes focus in on. When you look at what their interests are, explore outcomes then that support the interest of the individuals and not the positions. Also, in a hospital situation, you want to identify what is your WATNA and what is your BATNA. What that means is WATNA means the worst alternative to a negotiated agreement and BATNA means the best alternative to a negotiated agreement. Anytime you're in a dispute, anytime you're in a hospital situation, you're basically in a negotiation. What you're looking at with a BATNA and WATNA is if we can't resolve this and come to an agreement, what's the worst case scenario? What could happen then? What's the best case scenario that could happen? then you use that as far as being starting points to kind of negotiate what may be a solution there. You may also want to ask questions that help lead the person to an answer. We generally don't like being told what to do. This goes back to where we went a while ago with autonomy. But now if you can make me answer some questions that basically leads me to believe, well, I came up with a solution on my own, even though that was the solution you were going to recommend anyway. If you make me feel that I came up with it, chances are I'm going to go along with that a lot better than I would if you just said this is what I recommend you do. Also, I would seek minor agreements because it becomes like a snowball effect where the minor agreements lead to more major agreements and you start getting better and better. And next thing you know, what was fairly hostile has now become a relatively calm conversation. I'd also recommend brainstorming ideas as far as asking the other person who is hostile with you, how do you suggest we handle this situation? And I know a lot of times the disagreements may be on things that policy says that the hospital has to do this. And you may say, well, we don't have much room to negotiate from that. That's fine. Explain that to the patient or the patient's family. And here again, allow brainstorming and let them know, okay, if you were in my shoes, knowing that I'm limited, I can't do this or I can't do that, in that position, what would you do if you were me? How would you handle this? Help me understand what I could possibly do to help you better. Strategy three, and this is the physical side of things. Always keep sight of the person if they're becoming, I would say keep sight of the person even if they're calm because you never know when somebody is going to all of a sudden flip and you never know when something's going to trigger the person. But especially the person is actually demonstrating some hostile tendencies. Keep sight of the person. Do not take your eyes off of them. Definitely do not turn your back to them. Don't give them the opportunity to assault you and everything. I would also recommend that you meet with them in a room with no weapons. Now, you may say, well, that's no problem. In a hospital room, there is no guns. There is no knives. There's none of that kind of stuff. There could be other things in there that they could use as weapons though. Even if you have, using an office setting as an example, even if you have a stapler in there, you can mess somebody up seriously with a stapler, even though that is not really classified as a weapon. So you want to meet with them in a room that is avoid of any type of items that could be used as a weapon. With that being said, you want to maintain a clear path to the room's exit. Don't let them get in between you and the room, the door to the room. If you're at a desk, make sure there's a clear path from your seat at your desk to the door to the room. You never want them to take that avenue of escape from you. I need to go back to, and I said, meet with them in a room with no weapons. And I think this is on the next slide actually, but I'll go ahead and mention it here. When you have somebody who is hostile or displaying hostile tendencies, take them out of the lobby or the waiting room or wherever they're at. Take them to another environment, to another room that is a safe place to meet with them. The reason you want to do that is it's easier to get them to de-escalate when they're by themselves than it would be when they have an audience. So take them and meet with them individually. You also want to maintain physical space with the person. We oftentimes talk about our comfort zone, that area around us, that little bubble we operate in. But make sure that you allow enough space between you and the other person that you have room to react in case they do try to do something. I would also, even in that environment, recommend having a co-worker present. I wouldn't have a lot of co-workers present, though, because if you have a patient in one room, even though they are getting a little hostile, and now you have six or seven co-workers in there with you, you're kind of creating a situation that is going to escalate the conflict and hostilities of that patient simply by that show of force of having too many people present. If you can't have a co-worker present with you, though, I would at least make sure I have some co-workers who are within earshot of me calling out that I need help or I need assistance. Strategy four, and this is behavioral, which kind of goes along with physical a little bit, but there is some differences here. As I mentioned a few moments ago, you need to isolate the person who's becoming hostile. I've already mentioned that. With that, too, when you're brainstorming potential solutions, seek win-win situations. Seek situations where both people are able to win. This is very difficult in some situations, but a lot of times I think we're conditioned in our society that if we reach any agreement, it is going to be a win-lose agreement. Somebody's going to win and somebody's got to lose, but that isn't always the case, though. There's a lot of times, especially when we're in arguments and conflict, we can reach a win-win solution where both people are at least somewhat satisfied. Try to separate the people from the problem. A lot of times we say that the person is the problem. Well, maybe in some small cases, maybe, but most of the time the person isn't the problem. The problem is usually something else, whether they may be afraid, whether they may be confused, whether they may feel as if they have no say-so in the decisions that are being made about their health and their treatment plan or whatever. There could be several things here that could be the problem that could be easily resolved, but it's not the person that is the problem. When we view the person as the problem, we're already damaging our own opportunity to resolve the conflict. I would also encourage to keep them talking, not keep them yelling and making threats, but keep them talking at a reasonable level because the more they talk, they will eventually run out of steam and they will start de-escalating themselves. This is one reason why if you ever have a complaint about a product or something and you call the customer support line, this is the reason that customer representative keeps you talking because they know that as long as you're talking, you're going to soon de-escalate yourself because you're going to run out of steam. Also, I've already mentioned this, but here again, it's very important, use active listening. Try to listen to understand the person, not to reload. A lot of times we are listening to the person simply for the fact that I want to hear what they're saying so I know what I need to say next. We're not really listening to them to understand what concerns they may have. Active listening basically involves us being present in the moment and listening to exactly what they say. If we don't understand, ask them clarifying questions, but to really be fully involved in the moment itself. I would also encourage using I statements instead of you statements. Whenever you use statements that start off with you, well, you did this, you did that, you acted this way or you stated this, you're basically putting blame on the other person when they're in a defensive or hostile state already. You putting blame on them is only going to add to the hostilities. What you can do instead is say, okay, I hear what you're saying. That makes me or in response, I feel this way or I think that. Use I statements. It's a lot more effective. Lastly, on this slide, when you're talking to somebody and they say something they won't and you know that it's realistically not an option, respond by yes and statements. Don't use yes but. A lot of times we'll say, you know, yes, but our policies, we can't do that. Yes, but we can't. What you're doing then by saying but, you're calling that person to become more hostile, more defensive because you're saying yes, I hear what you're saying, but that but shoots down everything that they just said. When you say yes, then say yes and how do you suggest we reach that when policy says this or yes and I understand what you're saying, but how did you come to that conclusion? So how does all this apply for hospitals? There's several things I have listed there. I'm just going to kind of, you know, for sake of time kind of encapsulate all that in a nutshell here. We need to watch how we interact with patients and their families. A lot of times our staff members, our nurses, our doctors or whatever, they're pressed for time. They're already doing a lot of duties out there. We've already talked earlier on about how, you know, there's workforce shortages and everything and so hospitals are having to do more with less workers. So what that does then a lot of times is causes us to rush through our treatment with individual patients. Somehow we need to find a way to stop that. We need to learn how to, you know, kind of calm down, take our time with this patient, focus on quality interactions with the patients where we're actually communicating them transparently and in a way they understand. We're not using medical jargon. We're not trying to show them how intelligent we are. You know, who cares what degree you have or where you received your medical degree from. If the patient doesn't understand what you're trying to do or what you're suggesting, all of your knowledge is useless basically. So if we can communicate with these patients in a very clear, transparent way and address their concerns and address their questions and stuff, that goes a long way to building rapport with them. But it also enables us to get to know the patient as a person and not just as a number. You know, also with us being in a hurry and a rush to get things done, you know, a lot of times we don't pay attention to our surroundings. We don't pay attention to the patient. We don't pay attention to the patient's mood and how their mood may be tremendously different than it was yesterday or early this morning. And we may not even know what's caused that mood change. So we need to become more aware, more, this is a people business and we need to focus more on the people than what we've gotten to because of the workforce shortages and the increased job duties and things of that nature. And I know it's a challenge, but we've got to get back to basics somehow on that. So the circle of peace is something I came up with a few weeks as well. This kind of highlights the four dimensions or components to conflict, you know, the physical, the mental, the emotional, behavioral. And as long as you're taking care of all four components of conflict, then basically what you have, you've created a circle of peace there where people are getting along. The conflict or hostile situation has been able to be de-escalated, but the circle of peace also keeps in consideration that conflict is multi-dimensional. So our solutions have to be multi-faceted. You know, we can't just approach the physical side of it and everything. These tactics that we've gone over addresses the root causes of it. It gets to the solution to the conflict by looking at the root causes and not just the actual symptoms of it, which is what a lot of times is addressing the physical aspect of conflict does. So what are some of the outcomes? These are just some of the typical outcomes that people and organizations experience by implementing the tactics that we just talked about. Number one, you do have a safer workplace with less hostilities and everything. Definitely in a hospital setting, you have improved patient care. You develop a better reputation in the community, which leads to better feedback from the community, even increased usage by the community because now they're going to you because of your reputation, because of the stellar patient care that you're giving to patients and stuff. Another thing, and this is a lot of times due to my legal background and stuff, significantly reduced liability, okay? That is always a huge thing for organizations is to reduce that because no one likes being involved in a lawsuit, nobody likes going to court, especially when it can be quickly and easily resolved. You also have an improved reputation, which I just mentioned, and also you have increased employee retention. People decide to stay with you. Your reputation as an employer goes up tremendously. You're then able to recruit and attract better quality employees or candidates for employment, and your organization becomes a top employer for its reputation and the way it treats and looks after its staff. So, in summary, our most successful weapon against conflict and potential violence is our ability to effectively communicate with others. One of the things I have come to realize and know based off of my experience is that our ability to communicate is critical to everything that we do. Having dealt with hostile, violent people and people with violent tendencies in the past, I learned really quick that you can talk yourself into a very violent, hostile situation, which nobody wins in. You can also talk your way out of it. It really depends on what you prefer to do, okay? And it depends on what you're willing to do and what you're able to devote the time to. So, the problem is that we talked at the beginning that healthcare is growing increasingly more violent, and it doesn't seem to be, you know, residing anytime soon. Currently, cost-cutting tactics of having internal teams and security is not working to reduce conflict and violence. It's still happening because these internal teams and security is reactive instead of being proactive. The solution to this is that improving our ability to communicate, negotiate, and to utilize self-awareness and active listening is critical, especially if we look to proactively diffuse a situation before it becomes increasingly more hostile. And these tactics work and will help you achieve multiple goals. I've used them time and time again in organizations. I've used them time and time again with violent populations and individuals. If you take the time to implement these, they will work. The challenge is that it takes time, and that's oftentimes what we don't want to do. Because as a nurse, I may have to get off in 30 minutes with my shift ends, but I still have five, six, seven, eight patients I need to see. I don't have the time to simply deal with this one person. That leads us into conflict. It gets us into hostile situations. So, time is critical. With that being said, I think we have a few moments for questions. If anybody has any at this point, Lindsay, I'll turn it back over to you. Thank you all for allowing me to be here. Perfect. Thank you so much, Dr. McIntyre. I see one comment here that says, I have found this presentation very beneficial. Actions were shared that can definitely be applied to practice in the hospital setting, and thanking you for that. Thank you for that and everything. And you know, also one thing that I did develop, I didn't mention a few moments ago, when we were talking about the five core concerns and stuff, where emotions really spring from. I've also developed a resource out there that's free, that's basically 25 ways to calm emotions in conflict, that really is based off of those five core concerns that we talked about, and things you could do to address those in conflict. So, hopefully that'll help de-escalate as well, if anybody's interested in that. Or if anybody has any information, please reach out to me. My whole purpose is to help make your workplace simpler, and more safe, and give people, not just in healthcare, but people overall in workplaces, the tactics and strategies to reduce conflict. That's wonderful. Thank you so much for sharing that resource. I did go ahead and just post some additional information for you all in the chat, as well as a reminder, you will receive an email tomorrow morning. Just note that it will come from educationnoreplyatzoom.us. And so, because it comes from that Zoom email address, it may get caught in your spam, quarantine junk folder, something of that nature. So, if you don't see it in your inbox in the morning, I would encourage you to go check those additional folders. And then, if it's still not there, and you'd like to go back and access the recording of today's presentation, you can always use the same Zoom link that you used to join us for the live presentation, to also access that recording. And then, just note that we do have an additional security measure in place to protect Dr. McIntyre's intellectual property here. So, you will need to click on that Zoom link and type in your information. That will prompt an email to come to us to approve your recording access request. We do typically approve those very quickly, within a few moments of receiving them, but we ask that you give us one business day to approve those requests. And then, again, you'll have full access to the recording for 60 days from today's date. And then, also included in that email tomorrow morning will be a link to the slides that were presented today. But I did go ahead and provide that link there for you in the chat to have as a resource now as well. And of course, you see Dr. McIntyre's contact information here on the screen. So, you'll have that information there in those slides. And he did mention to me before we got started today that he is very open to you all reaching out. I know some of the situations may be more sensitive in nature, and you'd just like to have more time to discuss those situations with him. So, please don't hesitate to do so. And then, if we can be of any further assistance or if you'd like to pass questions through us, you can always reach us at education at gha.org. We'll be happy to help in any way that we can and possibly get your questions over to Dr. McIntyre as well. It's another comment here saying, thank you so much for this presentation. It was very informative. And I agree. Thank you so much, Dr. McIntyre, for your time and information that you shared with us today. We greatly appreciate it. And I hope you all have a wonderful afternoon. Look forward to having you all back with us for future sessions. Thank you so much. Thank you all. Bye-bye.

conflict resolution

de-escalation strategies

toxicity reduction

healthcare sector

effective communication

active listening

self-awareness

circle of peace model

proactive conflict resolution