Fostering Mutual Support in Faculty as a Means to Address Conflict

Teamwork training is an effective strategy to improve communication, collaboration and conflict resolution, and thereby combat faculty-to-faculty incivility in schools of nursing (American Nurses Association, 2015; Clark, 2013). Faculty reported in a national study that while direct communication is essential in addressing an issue, barriers existed to assertively dealing with conflict (Clark, 2013). Fear of retaliation has been noted as a main factor for circumventing the problems (Clark, Olender, Kenski, & Cardoni, 2013). Taking the initiative to deal with an uncivil coworker requires not only courage but the skill in handling conflict. Being able to provide feedback that is timely, respectful, specific and considerate will make the message more effective (Agency for Healthcare Research and Quality, 2017a). Unfortunately this is not an inherent skill, but must be learned and practiced.

A quality improvement study conducted by the School of Nursing at Northern Illinois University (SON) in 2017-2018 indicated a need for conflict resolution skills as measured by the TeamSTEPPS Team Perceptions Questionnaire (TPQ). The TPQ assesses the individual perception of group-level team skills in the areas of team structure, communication, leadership, situational monitoring and mutual support (AHRQ, 2017b). The TPQ was administered to faculty, instructors and staff at 3 time points between November 2017, May 2018 and August 2018. The first time point was a baseline measurement prior to an educational event addressing teamwork skills and the others were after the educational event. The educational intervention was an adaptation of the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum that was developed by AHRQ and the U.S. Department of Defense (AHRQ, 2017a).

RESULTS

From baseline TPQ to TPQ 2, 31 of 34 areas showed improvement with the greatest improvement in the domain of Mutual Support, specific to the questions: School of Nursing team members are comfortable bringing up challenges or concerns and School of Nursing team members resolve their conflicts, even when the conflicts become personal.

In the baseline TPQ, 22% of the respondents (n=49) agreed with the statement that School of Nursing team members resolve their conflicts, even when the conflicts become personal. The TPQ 2 indicated that 42% of the respondents (n=38) agreed with that same statement.

For the question When School of Nursing team members have a concern, they challenge others until they are sure the concern has been heard, 29% of the respondents at baseline agreed with statement and at TPQ 2, 54% agreed.

Discussion

Mutual Support is an essential team behavior and involves task assistance as well as giving and receiving feedback. This is not a skill that all of the faculty, instructors and staff at the SON possessed. The educational event presented as part of the QI project introduced tools and techniques that could be used for various conflict situations (O’Sullivan, Moneypenny, & McKimm, 2015). The CUS technique is a tool for advocacy, assertion, and mutual support using “signal words” to catch the team members’ attention. The first step is to say “I’m Concerned” followed by the concern. If the concern is not taken seriously, the script progresses to “I’m Uncomfortable” followed by the reason and finally if concern continues to go unnoticed, “This is a Success issue” will be stated. Once all team members understand the progression, the individual typically does not progress past the first “signal words” of “I’m concerned”.

The DESC script can be used for both informational and interpersonal conflict (AHRQ, 2017a) and is an acronym for D - Describe the specific situation, E - Express/Explain your concerns, S - Suggest other alternatives and C - Consequences should be stated. In the SON, several team members have adopted this technique when addressing interdepartmental issues as well as student issues.

Confronting conflict takes courage and a defined skill set. Sharing tools to provide structure for a difficult conversations promotes effective feedback and ultimately better working relationships. In addition, encouraging positive feedback will reinforce positive behaviors and value as a team member (Keller, Eggenberger, Belkowitz, Sarsekeyeva, & Zito, 2013).

The panel will address how we have used these techniques and how they have been both embraced by most, but not all, faculty and the experience of implementing this program as part of a series of team building efforts.