Communication and conflict resolution

Dr Marelise Kruger

Dr Judy Marois

Dr Tyson Bodor

Sharad Kerur - mentor

• When conflict is ignored or mishandled, it doesn’t just affect the workplace—it quietly shapes how others see us as a person.
• It can signal a lack of leadership, weaken trust, and even slow career growth.
• SOFT skill – SURVIVAL skill – SUMMIT skill? ��Building one’s conflict intelligence, competence and capacity is more than just skill building—it’s a hidden career advantage that can build trust, credibility, and influence.

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Workshop objectives

• Understand personal response to conflict
• Understand the dynamic of the conflict cycle
• Develop skills in.
• TeamSTEPPS : CUS
• Assertive communication (DESC model)
• Reframing statements
• De-escalating conversations (video only)

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Agenda -3 hours

the power of communication��WELCOME AND GROUND RULES - 10�( Dr Marois )�

• facilitator introduction
• confidentiality, psychological safety
• ground rules : participation , phones and computers off
• boundaries : not high-level conflict resolution

Ice breaker - 40

“HOW I REACT IN CONFLICT”

• 10 min in groups of three
• 30 min group discussion

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• Dr Bodor - intro

What conflict feels like

Starter questions.

• When conflict comes up, what’s your natural “go-to” response?
• Explain? argue? Avoid? Accommodate?
• What works with this response?
• What doesn’t work with this response
• What feels most important to you when you are in conflict?
• Being heard? Reaching agreement? Preserving relationship?
• Something else?
• How do you notice your body reacts when you’re in conflict?
• Posture? tone? facial expressions? breathing patters? flushing?
• How do you usually feel immediately after a conflict?
• Angry? Anxious? Guilty? Relieved? Motivated?
• After conflict what is your usual way of processing it – do you replay it in your head, talk it over with someone or try to move on quickly?

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2-3 person discussion group

10 MIN OUT TIME

30 MIN BIG GROUP DISCUSSION

• Balancing empathy and assertiveness is difficult
• Easy to slip into extremes:
• Retreating to avoid conflict
• Getting aggressive to defend your position
• Middle ground requires listening without losing your own voice
• True resolution comes when both perspectives are heard and respected
• Sometimes retreating or being firmly competitive is the right choice, depending on context

TKI – Thomas Kilman Index

Zone of tolerance

• The space where we can stay engaged with conflict
• Emotions are felt but not overwhelming
• We avoid slipping into reactive modes:
• Fight – aggression
• Flight – avoidance
• Freeze – shutting down
• Fawn – appeasing
• Fix – rushing to solve without listening
• Conflict is processed in the moment, rather than replayed for days
• Allows for curiosity, perspective-taking, and constructive dialogue

The anatomy of conflict- 30

“CONFLICT CYCLE AND LADDER OF INFERENCE”

• 10 min presentation
• 30 min small group activity
• 5 min feedback

The ladder of inference - How Our Minds Climb�

We notice selected details from the pool of observable information

We add meaning based on personal filters (perspective, past experience)

We make assumptions → often unconscious

We draw conclusions and solidify beliefs

These beliefs drive our actions in the conflict cycle

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🧠 Key Point: By slowing down the climb, we create space for curiosity and empathy — reducing reactivity and keeping the conflict from escalating.

Scenario

• Two colleagues — Riley and Morgan — have worked together on several projects.�Earlier in the year, Morgan gave Riley critical feedback in a group meeting, saying Riley’s presentation was “confusing.” Riley felt humiliated and has been wary of Morgan since.
• A few months later, Riley sent Morgan a detailed proposal for their next joint project. Morgan replied two days later with only: “We should talk.”
• Riley immediately assumed Morgan didn’t like the proposal and felt deflated.
• Now, they’re both in a team meeting. Riley shares an update about the project timeline. Halfway through, Morgan starts scrolling on their phone and whispers something to another colleague. Riley notices, pauses, and says curtly:
• “If this isn’t important to you, I can stop presenting.”
• The room goes quiet. Morgan looks surprised:
• “What? I was just checking a message from the vendor about our deadline.”

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3-4 person discussion group��10 min out

BREAK� 10 MIN

COMMUNICATION SKILLS �TOOLKIT – 80

Effectively communicating involves not only delivering a message but also resonating with the experiences, values, and emotions of those listening.

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It requires

• humility and curiosity.
• suspending judgement
• listening deeply for understanding
• clarifying meaning
• regulating emotions

COMMUNICATION SKILLS �TOOLKIT – 80

Effectively communicating involves not only delivering a message but also resonating with the experiences, values, and emotions of those listening.

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It requires

• humility and curiosity
• suspending judgement
• listening deeply for understanding
• clarifying meaning
• regulating emotions

COMMUNICATION SKILLS �TOOLKIT – 80

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Practical:

Brief introduction + paired practice; 3 groups with coaches – 20 min each

• CUS -Concerned/ uncomfortable/safety TeamSTEPPS
• Assertive communication (vs passive/agressive) PRACTICE DESC
• REFRAMING

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De-escalation (tone, pace, naming tension) – video only

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COMMUNICATION SKILLS �TOOLKIT – 80

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Practical:

• CUS

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• DESC

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• REFRAMING

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• De-escalation (tone, pace, naming tension) – video only

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TeamSTEPPS : CUS

TeamSTEPPS is an evidence-based framework to optimize team performance across the healthcare delivery system.

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TeamSTEPPS : CUS

TeamSTEPPS

Team Strategies and Tools to Enhance Perfor­mance and Patient Safety

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Evidence-based framework to optimize team performance across the healthcare delivery system

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CUS: Concerned, Uncomfortable, Safety

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TeamSTEPPS: The CUS Tool

A graded assertiveness strategy to raise concerns clearly and professionally

CUS = Concerned → Uncomfortable → Safety Issue

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How to Use CUS:

“I am Concerned” – State concern directly

• Ex: “I’m concerned about the patient’s blood pressure falling.”

“I am Uncomfortable” – Escalate if concern not addressed

• Ex: “I’m uncomfortable with the late decelerations — we need to investigate further.”

“This is a Safety Issue” – Clearly identify risk

• Ex: “I’m uncomfortable moving forward without an interpreter; this is a safety issue.”

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Purpose of CUS:

Empowers patient advocacy at all levels

Improves team communication & collaboration

Helps prevent harm by prompting timely action

Challenges bias & assumptions that may minimize risk

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TeamSTEPPS: The CUS Tool

A graded assertiveness strategy to raise concerns clearly and professionally

CUS = Concerned → Uncomfortable → Safety Issue

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Purpose of CUS:

Empowers patient advocacy at all levels

Improves team communication & collaboration

Helps prevent harm by prompting timely action

Challenges bias & assumptions that may minimize risk

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TeamSTEPPS: The CUS Tool

How to Use CUS:

“I am Concerned” – State concern directly

• Ex: “I’m concerned about the patient’s blood pressure falling.”

“I am Uncomfortable” – Escalate if concern not addressed

• Ex: “I’m uncomfortable with the late decelerations — we need to investigate further.”

“This is a Safety Issue” – Clearly identify risk

• Ex: “I’m uncomfortable moving forward without an interpreter; this is a safety issue.”

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Scenarios

• Scenario 1: During a long case, the patient’s blood pressure gradually drifts downward. The attending anesthesiologist seems focused on teaching another resident about airway techniques and hasn’t acknowledged the low readings. Use CUS to have the low BP addressed

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• Scenario 2: A nurse hands you a syringe of clear fluid without a label and says, “It’s just fentanyl, I drew it up for you.” You are unsure whether it has been properly prepared and labeled. Use CUS to have a new syringe drawn up

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• Scenario 3: A patient with no English proficiency is in pre-op holding. A family member with limited English proficiency is translating informally, but no professional interpreter is present. The surgical team is eager to proceed. Use CUS to have translation services used for consent

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Scenarios

• Scenario 1:During a long case, the patient’s blood pressure gradually drifts downward. The attending anesthesiologist seems focused on teaching another resident about airway techniques and hasn’t acknowledged the low readings.

C I'm concerned about the patient's blood pressure falling.

U I'm uncomfortable with how low the blood pressure has become - we need to start treating it.

S I'm scared the patient will have a complication if we don't treat the low blood pressure, this is a safety issue.

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• Scenario 2: A nurse hands you a syringe of clear fluid without a label and says, “It’s just fentanyl, I drew it up for you.” You are unsure whether it has been properly prepared and labeled.

C I'm concerned about the preparation of this medication.

U I'm uncomfortable with using a syringe that I haven't prepared - can you show me the vial and how you prepared it?

S I'm afraid of causing a medication error, I need to see the preparation of the syringe and vial before using it, this is a safety issue.

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• Scenario 3: A patient with limited English proficiency is in pre-op holding. A family member is translating informally, but no professional interpreter is present. The surgical team is eager to proceed..

C I'm concerned about this patient's understanding of the procedure and the adequacy of their consent.

U I'm uncomfortable with proceeding - we need to confirm what the patient understands.

S I'm uncomfortable moving forward without an interpreter; this is a safety issue.

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Organize in 3 groups

Assertive communication DESC model

Assertive communication

Being assertive CONCEPT :

• Recognizing and naming our own needs and values
• Believing we have a right to those needs
• Having the courage to express them clearly and respectfully
• Balancing our needs with the needs of others

🧠 It takes self-awareness, confidence, and empathy — not just words — to stay in that balanced middle ground between passive and aggressive communication.

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DESC �examples

• Scenario 1: Dishes in the Sink
• You notice your roommate/partner consistently leaves dirty dishes in the sink overnight, and it bothers you.
• DESC practice:
• D:
• E:
• S:
• C:�
• Scenario 2: Phone at the Dinner Table
• During dinner, your partner frequently checks their phone while you’re trying to talk.
• DESC practice:
• D:
• E:
• S:
• C:�
• Scenario 3: Household Chores
• You feel like you are doing most of the cleaning at home, and it’s wearing you down.
• DESC practice:
• D:
• E:
• S:
• C:

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DESC �examples

• Scenario 1: Dishes in the Sink
• You notice your roommate/partner consistently leaves dirty dishes in the sink overnight, and it bothers you.
• Practice framing a DESC statement without blame:
• D: “The dishes are often left in the sink overnight.”
• E: “I feel stressed when I see the kitchen messy in the morning.”
• S: “Could we agree to rinse and load the dishwasher before bed?”
• C: “That way, mornings will feel calmer for both of us.”

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• Scenario 2: Phone at the Dinner Table
• During dinner, your partner frequently checks their phone while you’re trying to talk.
• DESC practice:
• D: “At dinner, the phone is often on the table and checked.”
• E: “I feel unimportant when I don’t have your full attention.”
• S: “Could we keep phones away from the table during meals?”
• C: “It would give us more quality time together.”

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• Scenario 3: Household Chores
• You feel like you are doing most of the cleaning at home, and it’s wearing you down.
• DESC practice:
• D: “Lately, I’ve noticed I’ve been vacuuming and cleaning most weekends.”
• E: “I feel overwhelmed managing it all myself.”
• S: “Could we split the chores more evenly?”
• C: “That would help me feel supported and give us both more free time.”

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Organize in 3 groups

REFRAMING

Re Framing

• Reframing = listening past the harsh words to the unmet need underneath
• Instead of reacting to the tone, focus on the intention or need:
• Respect
• Being heard
• Safety / fairness
• Collaboration
• Respond to the need, not the attack → this reduces defensiveness and re-engages dialogue

❌ “You never support me when I need help!”

✅ “Sounds like you really want backup when things get heavy — how can I step up more?”

• When we reframe, we shift the conversation back to needs and shared goals, calming the emotional brain.

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Activity: Reframing to the Positive Need

In groups, pick a few statements below. Identify the underlying need or value being expressed. Reframe it into a constructive statement that acknowledges that need.

• Negative / Aggressive Statements to Reframe
• “This team is useless — nothing ever gets done on time.”
• “Why do I always have to be the one who cleans up your mess?”
• “You don’t care about what I think — you just do whatever you want.”
• “That’s a stupid question. You should already know the answer.”
• “You’re so disorganized. I can’t trust you with anything.”
• “We’ve talked about this a hundred times and you still don’t get it.”
• “You only think about yourself. You’re so selfish.”
• “I’m sick of this — I don’t even want to work with you anymore.”
• “This is a complete waste of my time.”

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Reframing to the Positive Need

❌ “This team is useless — nothing ever gets done on time.”✅ “I get it, deadlines matter. What could help us stay on track better?”

❌ “Why do I always have to be the one who cleans up your mess?”✅ “Seems like you just want things to feel more fair. How can we split this up so it doesn’t all fall on you?”

❌ “You don’t care about what I think — you just do whatever you want.”✅ “Sounds like you want your input to count. Let’s slow down and make sure your ideas are in the mix.”

❌ “That’s a stupid question. You should already know the answer.”✅ “I think you’re wanting us to be better prepared. Let’s go over it so we’re on the same page.”

❌ “You’re so disorganized. I can’t trust you with anything.”✅ “I hear you — being able to rely on each other matters. What would help build that trust back up?”

❌ “We’ve talked about this a hundred times and you still don’t get it.”✅ “Feels like you want this to be clearer. Maybe we can try explaining it a different way?”

❌ “You only think about yourself. You’re so selfish.”✅ “Sounds like teamwork is important to you. How do we make sure both our needs are covered?”

❌ “I’m sick of this — I don’t even want to work with you anymore.”✅ “I can tell this is wearing you down. Let’s figure out how to make it less frustrating.”

❌ “This is a complete waste of my time.”✅ “I hear you — you want your time to count. How can we make this more useful for you?”

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Organize in 3 groups

De-escalation

De escalation

• De-escalation is the intentional reduction in the intensity or severity of a conflict, crisis, or potentially violent situation through communication, self-regulation, and other techniques, to promote a peaceful resolution
• calming down a heated disagreement,
• managing aggressive behavior
• empowering individuals to regain control and discuss issues calmly instead of resorting to conflict or violence. 

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What is a crucial conversation ?

De escalation

• De-escalation = Returning to the Zone of Tolerance
• Calming both ourselves and the other person so emotions don’t overwhelm
• Why it matters:
• Escalation narrows thinking, triggers fight/flight/freeze
• Early recognition prevents conflicts from becoming entrenched
• Quick repair helps preserve trust and psychological safety
• Key Skill: Notice physiological signs (tone, pace, body language, your own stress signals) that signal escalation is beginning
• 🧠 Neuroscience insight: High emotion shifts us into limbic “survival mode.” De-escalation brings the prefrontal cortex back online for reasoning and empathy.

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Skills for De-escalation

• Regulate Yourself First

Pause, breathe, lower your voice, slow your pace

• Acknowledge Emotions

Name what you observe: “I can see this is frustrating.”

• Refocus on Curiosity

Ask open questions, show genuine interest in their perspective

• Signal Collaboration

Use “we” language to show you’re on the same side

• Recognize when it’s deeper than the topic

Conversation may be shifting into values, needs, or identity

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• From Crucial Conversations: When people feel their worth, safety, or respect is threatened, emotions spike

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• De-escalation = Making it safe again so the real issue can be addressed

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SILENCE

DIALOGUE

VIOLENCE

Learn to Look

Crucial questions

IS SAFETY AT RISK/ HOW ARE OTHERS REACTING?

ARE WE IN DIALOGUE OR LOSING IT

Are we maintaining a dialogue, or is the conversation turning adversarial?

What can I do to bring it back to constructive dialogue?

AM I FOCUSED ON THE RIGHT PURPOSE

Am I staying focused on what I really want for myself, for others, and for the relationship?

Are signs of fear or silence (like withdrawing, avoiding, or sugarcoating) or signs of violence (like forcing opinions, sarcasm, or labeling) present in this conversation?

AM I IN A CRUCIAL CONVERSATION

Know your style under stress

SILENCE

DIALOGUE

VIOLENCE

Learn to Look

SMALL STEPS …��

WHERE TO GO FROM HERE

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• MRU UNDERSTANDING CONFLICT - ANNUAL " PEACE PRIZE"
• PERSONAL/SMALL GROUP COACHING
• HOME | CLARITY IN CONFLICT

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