In the last week, we have had interesting discussions about civility and its role in improving safety and quality of care and was presented at a Freedom to Speak Up conference. https://www.civilitysaveslives.com/
This led to further conversations about rudeness and manners and how those who have good manners seem to do better than those who are impolite.
We also recognise that there are cultural norms and those with neurodiversity that could be disadvantaged within this convention. We discussed how teaching negotiation skills was critical as part of communication style and that these could bridge these gaps.
The research cited in Civility Saves Lives included randomised trials such as ‘The Impact of Rudeness on Medical Team Performance: A Randomized Trial’ Riskin et al Pediatrics. September 2015, VOLUME 136 / ISSUE 3, where teams participated in a training simulation involving a deterioration in a patient. Participants were informed that an expert would observe them. Teams were randomly assigned to either exposure to rudeness (in which the expert’s comments included mildly rude statements completely unrelated to the teams’ performance) or control (neutral comments). The videotaped simulation sessions were evaluated by 3 independent judges (blinded to team exposure) who used structured questionnaires to assess team performance, information-sharing, and help-seeking.
Rudeness had adverse consequences on the diagnostic and procedural performance of the team and other research also reinforces that effective communication is critical for patient safety and threats to communication such as incivility should be eliminated from our organisational culture.
“Incivility often occurs when people are stressed, unhappy, and rushed. When these coincide, anything can happen. Incivility erodes self-esteem, damages relationships, increases stress, contaminates the work environment, and may escalate into violence.”
People are less creative when they feel disrespected, and people will reduce the quality of their work ‘quiet quitting’ or even resign.
Understanding how to negotiate may create different communication strategies available to us as an alternative to rudeness when under stress. It is noticeable that these are not taught in our traditional health and social care environments.
Negotiating Skills
Competitive
This competitive style which is often seen in our environment prioritises outcomes, adopting a position to succeed in goal achievement at the compromise of relationships. It can be characterised as a win-lose strategy.
Collaborative
The collaborative style of negotiation reflects a high importance for outcome, and a high concern for the relationship. This strategy tries to identify win-win opportunities and creates out of the box thinking to generate positive outcomes.
Accommodating
The accommodating style of negotiation reflects a low importance for outcome, but a high concern for the relationship and can be referred to as a lose-to-win strategy, where the accommodating party will back-off or give-in to preserve the relationship.
Avoiding
The avoiding style reflects a low regard for both outcome and relationship. A person adopting this position will withdraw. While this can be characterised as a lose-lose strategy, it usually involves ignoring the problem or walking away or may be perceived as ‘passive aggression’.
Compromise
The compromise approach to negotiation recognises both the relationship and outcomes, but rather than creating additional value so that both parties can get what they need, this style will “split the difference”. It is a useful fall-back position but does not always solve the problem.
Other forms of negotiation can be seen as borrowing, where the rules of reciprocity are not followed and solutions are presented as their own, without acknowledging the origin. This contrasts to the ‘con’ which is an unethical style that reflects a high importance for outcome, and deliberately inflicts damage on the relationship in order to achieve that outcome.
More complex styles of negotiation are captured in approaches such as ‘Walk in the Woods’ which is a method in which the parties identify the problematic issues and resolve the conflict through a systematic four-step process. This method is focused on a multidimensional approach to problem solving through interaction and creativity in order to reach to a mutually beneficial ‘shared solution’ and can be used with groups or between organisations.
The four steps of the ‘walk in the woods’ model are:
Step 1: Revealing Self-Interest
The first step is designed to break the ice between parties. At the very outset, the parties actively listen to each other in a non-adversarial manner in order to reveal the underlying interests of each party. This step helps to build trust, create self-awareness and better understanding between disputing parties.
Step 2: Enlarging Interest
In this step, the parties are directed to identify and list the points on which they agree or disagree. Then, the lists are compared to determine whether the agreements outnumber the disagreements or vice versa. This step helps the parties to focus only on the areas of disagreement and plan accordingly.
Step 3: Enlightened Interests
Once the points of disagreement are recognised, the parties brainstorm to identify preferable completely new and innovative ideas which were unlikely to be considered before.
All the new ideas are then categorised (1 = Consensus, 2 = Ambiguous, 3 = Complete Disagreement). The ideas in Category 2 are further reviewed before finally reaching a decision on acceptance or rejection. Now the parties are ready to approach the final stage.
Step 4: Aligning Interest
This is the conclusive bargaining phase, where the parties prioritise both what they want to ‘get’, and what they are willing to ‘give’. Based on the prioritisation, the parties finally negotiate and reach a conclusion that is mutually advantageous.
We recognise that negotiations often fail because of not understanding each other’s perspective and lack mutual respect. Trust and building relationships to see each other as connected not separate, is part of finding new solutions.
Marcus, L. J., Dorn, B. C., & McNulty, E. J. (2012). The walk in the woods: A step-by-step method for facilitating interest-based negotiation and conflict resolution. Negotiation Journal , 28(3), 337-349
When people become frustrated, rudeness is often seen and where this appears within teams or organisations, toxic cultures at work are the result.
Bullying, fear and burn-out are all consequences and further cause mental health challenges and distress. This leads to NHS safety (or wider organisations) issues and quality of care suffers.
In order to address culture, we need to relook at our human side ensuring psychologically safe spaces and consider how kindness, respect and empathy as a strategy are important foundations. Role modelling, coaching and understanding ourselves, others and the world we work in, alongside negotiation skills and creating a shared perspectives can enable us to move forward.
