Using the CDP in Health Care Settings

Over the last several years, there have been many articles highlighting the costs of unmanaged conflict in healthcare settings including medical errors, adverse effects on patient safety and quality of care, retention costs of direct-care providers, dysfunctional working relationships, poor communication, and even violence. The Joint Commission on Accreditation of Healthcare Organizations also has standards for maintaining conflict management systems which affect how these organizations conduct training and implement processes for dispute resolution.

Given the significance of quality care and the safety of patients, effective conflict resolution may play even a bigger role in health care organizations than it does in other companies. Using the CDP to analyze problem areas and then provide practical solutions for change enhances the capacity of health care professionals to work more collaboratively.

With its focus on actual conflict behaviors, the Conflict Dynamics Profile® (CDP) has proved to be a vital component in reducing the amount of conflict in health care organizations. Two CDP certified users, Dennis Dennis and Zona Boyum, have used the CDP extensively in this industry.

Client Use Case: Dennis Dennis, Consulting Psychologist and Principal at Care Full Conflict LLC

Dennis  has been involved with health care issues since 1980. “I’ve used the CDP on a wide spectrum—everything from a broad policy level to conflict training in health care education to working individually with nurses,” says Dennis. “Since the terms and behaviors on the instrument are fairly concrete and easy to understand, they help get conversations going on important issues.”

As an example, Dennis once used the CDP model to establish “rules of engagement” before facilitating a vigorous debate between lawyers and doctors on a variety of policy issues. After explaining the fundamentals of the model, he pointed out the benefits of the constructive scales, and was able to get both sides to agree to focus on these positive behaviors as the discussion progressed. Simple actions such as expressing feelings and reaching out opened the door to more robust discussions about the importance of listening and finding common ground (patient interests, for example) when trying to reconcile differing views. Likewise, getting the group to refrain from engaging in destructive behaviors paved the way for a smoother, less adversarial process. In other words, just having the basics of the CDP model and scales as a reference helped the two sides gain consensus about the standards of interacting with one another.

In another case, Dennis worked with a team of nurses where there was so much animosity among some team members that quality care and the safety of patients were being jeopardized, simply because the nurses refused to help each other with any patients not directly assigned to them. As part of the intervention, the nurse manager received feedback and coaching on the CDP-360 to learn how to set the right tone for her team and also how to intervene appropriately when necessary. Her team of nurses then took the CDP-I and went through a variety of training sessions. Dennis recognized that a crucial element was reshaping the culture of this team to appreciate and use the constructive scales. He also emphasizes how important it is to not just focus solely on individual skills but to consider team norms, dynamics, and the overall culture of the unit or organization as a whole when addressing conflict issues.

Since prevention is a key piece of the puzzle, conflict training in health care education is often the first step. One objective, says Dennis, is “convincing decision makers at a national level that conflict resolution should be an essential piece of the curriculum.” When he has used the CDP at colleges and universities, the response has been very positive. An Assistant Professor at the Buntain School of Nursing at Northwest University says that the “CDP has been a highlight for students in her Leadership and Management course for the past five years. It has helped them understand themselves and develop leadership skills.”

Dennis cites medical non-compliance as a growing issue that leads to a huge number of conflicts. One example is when so many patients don’t take their prescriptions as prescribed. Another thorny issue is ineffective performance management within health care settings where an employee’s bad performance is not addressed by a supervisor which then leads to increased tension, conflict, and bad morale among the larger team. Dennis points out that health care workers often have to manage skills that they never were taught in their undergraduate studies. He says when you evaluate the huge costs associated with turnover, it is well worth any financial investment an organization makes to get employees trained upfront in conflict resolution. A study reported in the American Journal of Maternal/Child Nursing (March/April 2005) shows that the cost of replacing a specialty nurse is 156% of annual salary. So, the cost-benefit of retaining just one nurse by resolving a conflict is substantial. “Conflict management should be part of the orientation program within the first 90 days of employment. Having a common model and skill set helps change the overall culture,” says Dennis. Unfortunately, finding the money for training and actually pulling people away from their jobs to get them to the training is difficult, but Dennis notes that “the real cost of not doing it is even greater.”

Another area where the CDP has the potential to open up lines of communication is within dentist offices. Dennis notes he has seen a pattern with these small, entrepreneurial businesses where the dentists are highly trained professionals, but they haven’t had much training in interpersonal skills. The model has been to spend a lot of time enhancing technical expertise but maybe avoiding time spent on conflict because it’s not revenue generating. There are also issues involving boundaries of behavior between the “back office” and in front of patients. Highlighting the differences between the constructive and destructive scales on the CDP helps to reduce these common disputes.

Client Use Case: Zona Boyum, Succession Planning Coach, BayCare Health System

The impact of culture in reducing conflict is also stressed at BayCare Health System in Clearwater, Florida. Zona Boyum, Succession Planning Coach, heads up the education services department and developed three mandatory classes for all managers to take within two years of being hired. Boyum says the company requires this training so that there is a “common thread” throughout the organization, and the conflict management process will have a wider scope of influence on the overall culture.

After completing a prerequisite course on understanding the impact of change, managers then take a day and a half program called Responding to Conflict Effectively. Before participating in the program, managers are not only required to complete the CDP-360 themselves, but they also must have a boss, and at least three direct reports and three peers complete the survey as well because Boyum wants the feedback to be as meaningful as possible.

Day One of the program starts with an overview of the CDP in the morning. In the afternoon, participants go through three different rounds: watching a video by photojournalist Dewitt Jones which addresses the issue of perspective taking and framing problems in a different way, engaging in a 50-minute one-on-one feedback session with a CDP-certified coach (coaches are internal employees from myriad areas of the organization), and, finally, developing an action plan for the future. On the second day, participants work in triads and are videotaped in conflict role plays that are specific to BayCare. This exercise gives managers an opportunity to apply new insights to real-world situations.

The third required class is Mediating Workplace Conflict, a program adapted from Dan Dana. “This class is especially effective for Nurse Managers who deal with huge staffs and aren’t able to supervise every single conflict that might arise on any given day. It’s important for employees to learn how to manage common disagreements without having them in front of patients or their families,” says Boyum.

After completing these three courses, BayCare managers then go through a two-day course (Leadership Profile) which pulls everything together from the previous classes. In addition to reviewing the CDP, facilitators also highlight feedback from the Kirton Adaption-Innovation (KAI) Inventory. Many of the activities are videotaped and debriefed, and participants are able to concentrate on strengths and development needs, apply elements of their action plans, and actually practice new skills. If it’s determined that a manager still needs extra help in any one area, additional coaching is available. Again, Boyum stresses the goal of everyone having a common vocabulary for resolving conflicts and being proficient in constructive behaviors so that unproductive conflicts can be diffused or prevented right from the start.