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Elizabeth Kim and Jenritchel Tamayo

Leadership Portfolio Part 3 Group Assignment

MPH 610: Lead Practices

Los Angeles Pacific University College

Professor Robinson

MPH610: Leadership Portfolio- Part Three

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Conflict Negotiation and Management

Names of Team Members:

Elizabeth Kim
Jenritchel Tamayo

This worksheet is based on a conflict negotiation model taught in the public training program of
the Louisiana State Civil Service. Begin by reading the below scenario. Then, working as a team,
complete the worksheet.

Scenario
Emilio Sanchez was born and resides in Mexico, and was visiting his aunt Tania in the
US when he fell off a ladder at her home. Emilio is a 22-year-old single man who works as an
assembler in a manufacturing facility. He has a secondary school education, and speaks, reads,
and writes fluent Spanish. Mr. Sanchez took English courses in high school and his
comprehension is good, but he has trouble carrying on a conversation in English. His English
reading and writing skills are extremely minimal.
Mr. Sanchez was in otherwise good health when the accident occurred, but he suffered a
traumatic brain injury (TBI) when he fell, as well as a fractured tibia and wrist. His wrist and leg
are giving him little pain, but the TBI is a concern. He definitely improved while an inpatient,
but he has continued problems with balance and with following instructions without multiple
reminders and prompts. Speech therapy was initiated as he was nonverbal for a few days after
the accident. All therapy stressed the use of the English language. Each therapist commented that
Mr. Sanchez had difficulty following simple commands in English and preferred to communicate
in Spanish even though only one therapist was somewhat fluent in Spanish.
Mr. Sanchez enjoyed his inpatient therapy, but the clinical staff wasn’t sure he was taking
it seriously as he seemed to want to socialize – which was difficult since other patients didn’t
understand Spanish. He became increasingly distracted and uncooperative when tasks involved
speaking or understanding English.
Mr. Sanchez is being discharged soon. His aunt, who would like to provide home care for
him, is also not fluent in English but can speak, read, and write more than Emilio. She doesn’t
want to send him to a rehab facility, and it’s uncertain whether the primary concern is financial
or cultural. She does seem invested in his recovery, as she visited him almost every day and has
been willing to let a caseworker do a home visit prior to discharge. The treatment team, however,
feels very strongly that Mr. Sanchez needs to get to an inpatient rehabilitation facility where his
intensive therapy will assuredly continue.
You are his caseworker and must balance the needs of Mr. Sanchez with the realities of
the situation regarding his aunt’s desire to take him home and the therapy staff’s desire to have
him go to a skilled rehab facility.
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Conflict Management Clarifying Questions

1. Identify the problem. Do you have a sense that this is a symptom of a larger issue?

Emilio Sanchez is a resident in Mexico who was currently visiting his aunt Tania in the

U.S. An accident occurred when Emilio fell off a ladder from his aunt Tania’s home and suffered

from a traumatic brain injury (TBI). In result, he had multiple problems, such as the difficulty of
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balance, following directions, and he became an inpatient receiving therapy including speech.

However, another concern was the language differences as a barrier to quality and safety in his

care. Emilio’s English writing, reading, speaking, and comprehension is extremely limited and

minimal, while his aunt is also not fluent in English. Therefore, they both do not have the ability

to fluently understand the treatment plan directed by his healthcare providers nor do they have

the full understanding on how to apply other options for his care upon his discharge. Despite this

current situation, there is a sense that this is a symptom of a larger issue. This communication

between treatment team members, Emilio and his family member is a core component of health

care. In order to have a proper prognosis and diagnosis, it is critical to collect accurate and

comprehensive patient-specific data. For instance, informed consent, proper explanation or

instructions with a translator, and appropriately educating the patient and families. At the time of

Emilio’s care in the hospital, there was a lack of counseling and effective communication or

comprehension between the clinicians, health care providers, the patient, and the patient’s family

member. Due to the absence of comprehension and effective communication, it puts the patient

at risk for safety, the provision of health care needs, errors, and overall poor quality care.

Poor quality care may lead to other chronic health conditions or disability issues. At this

time there are other concerns such as financial barriers that we are unaware of meaning would

Emilio and his family member be able to continue paying for their medical bills and other

personal bills which leads to unforeseen circumstances where they may not have anywhere to go

after treatment. Due to the language barrier, it also puts the risk of Emilio and family members

not receiving the full treatment that is needed to properly heal his brain injuries and fractures he

received after his fall. The other problem I see is not only for this specific patient; however, the

other incoming patients that only speak one language. They will continue to have these barriers
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with communication and other issues that may increase the risk of their health. The organization

is not offering a patient-centered communication and delivering the utmost care that they can by

engaging their patients during the most critical parts of their healing duration.

2. Identify emotions. Identify the emotions of the characters in the scenario, and how they
may be affecting the problem.
Although Emilio may seem to be enjoying his inpatient therapy, his clinicians and health

care providers stress the language barriers while trying to provide the proper care. Healthcare

provider’s attitudes, language, and cultural barriers may negatively impact their views towards

their patients. Despite the difficult encounter with Emilio, they seem to be aware of their

emotional reactions and remove themselves to avoid potentially negative situations. Due to the

cultural and language differences, the treatment team has the desire for Emilio to receive further

treatment therapy at a Skill Rehab Facility.

We have also identified various emotions from Emilio and his Aunt Tania who may

become stressed due to the poor communication among all the healthcare providers. Meanwhile,

Emilio may experience a number of emotional changes or behavioral difficulties due to this

traumatic brain injury. In this case, Emilio may experience deficits in his communication skills

like listening to his therapists, awareness of the appropriate use of non-verbal communications

and taking turns in conversations. The healthcare providers seemed hesitant to go above and

beyond for a patient that had recent traumatic brain injury by not giving him the support and care

he needed especially during his beginning treatment. The healthcare professionals were aware

that his English was minimal yet they continued the treatment process in English but faulted the

patient. I felt the negativity from the healthcare professionals not offering care and empathy. This
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lead to a bad treatment where Emilio felt lonely and stopped by socially active perhaps due to

that language barrier he went through.

3. Identify the impact. How is this problem affecting team members or the workplace in
general?
Although healthcare providers and staff members are trying their best to provide quality

care, often time the lack of trains impedes their ability to implement competent care. According

to this case, ineffective communication may lead to host a number of issues and concerns. Which

may result in language and cultural barriers jeopardizing the hospital system’s effectiveness and

disadvantage of individuals who do not speak or who are not able to speak fluent English. As

language barriers demonstrate one of the great contributors to health disparities, which is a

significant implication.

The teamwork is very poor because each teammate is not effectively communicating with

each other and using all their resources within the organization. They were not offering Emilio

and his family member the top quality care or service per say because they wanted the patient to

participate during the treatment and during socialization. However, not once did I read that they

offered Emilio and the patient the language that they needed to fully understand the treatment

process and how to communicate effectively. Miscommunication led Emilio being discharged to

another treatment center yet Emilio nor his aunt seems to understand what the protocol is and

how to effectively treat Emilio so his aunt wants to take him home without proper equipment or

treatment at home. This barrier with miscommunication may become life-threatening for Emilio

if they do not effectively inform Emilio’s aunt the reason he must stay at the treatment center for

a while longer. This may potentially lead to a lawsuit if they wrongfully discharge a client
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without a proper understanding of the potential risks of taking Emilio home or even to offer a

safe place for Emilio to continue his treatment plan at home effectively.

4. Identify the parties. Who is involved in and affected by this situation?

Emilio- whom is the most affected by this situation, as he will make the primary decision on

whether he would like to pursue treatment in a skilled rehab facility. He had a traumatic brain

injury and the treatment seemed to be effective yet we are unsure of how much longer he needs

treatment. Miscommunication may lead to a life-threatening situation for this patient.

Aunt Tania- whom is also most affected by this situation, as she is the only family member who

is supportive and the willingness to provide home care treatment. Although she can understand

English a bit more than Emilio, she doesn’t seem like she completely understands the reason why

Emilio needs to be discharged to another treatment center. Aunt Tania is proactively helping

Emilio yet she wants to take him home. We are also unsure if she wants to take him home due to

financial issues or because she does not fully understand Emilio's diagnosis.

Clinical staff- They have provided care for Emilio although, he appeared to be distracted and

difficult to communicate with. They did not effectively communicate or properly offered quality

care to Emilio by offering his language throughout his treatment.

Therapists- The therapist has difficulty communicating with Emilio during his treatments. They

made several remarks by providing him with multiple reminders and instructions in order to

follow through. Although they had one staff that can speak Spanish, the team of therapists did

not offer the language support he needed despite his traumatic brain injury.

Treatment Team- The team desire for Emilio to continue his need for intensive treatment as an

inpatient in a rehabilitation facility. I felt that the treatment team did not offer the best
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communication with the family member, the aunt who is going to be taking care of Emilio by

explaining the need for the treatment process and how much longer he needs treatment to have a

successful recovery.

Case Worker- This professional worker will play a significant role in assisting and directing

Emilio and his family to the proper care. Additionally, the caseworker will be a great resource

management, as they are driven by their client’s needs and the right of self-determination is

emphasized. The caseworker should be able to offer resources to the patient and the aunt during

this time when there’s a lack of communication by offering advocacy and support.

5. Identify the outcome. What does a successful outcome look like?

With further assistance from a caseworker it could lead to successful outcomes. For

instance, this is a possibility that Emilio and his aunt will receive various resources and

therefore, they will both have further support and assistance to identify Emilio’s choice of

treatment care upon discharge. The caseworker should help the patient and the family member to

bridge the gaps with communication barrier and offer language assistance by providing

interpreters throughout the discharge process to make sure that the aunt has equipment at home

for Emilio and understand how to offer him treatment at home if she will be taking care of him.

However, after the aunt finds out that it may be too difficult for her to fully offer that assistance

to Emilio it would be best that he stays at the treatment center to further receive his treatment.

Also, the patient should be aware of all the treatment process so that he can make the final

decision if he is alert and oriented. Only because the aunt wants to take him home does not mean

Emilio should go home, the patient always has his choice unless he is unable to make that

decision for himself. At this time, we are unsure of his alertness due to his traumatic brain injury.
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Meanwhile, the hospital will create a better understanding of how to overcome language

barriers upon this encounter. It is significant to understand the role that communication and

language play a critical role, especially among healthcare organizations experience culturally

diverse populations. The hospital should consider utilizing technology by using Skype or

smartphone cameras with other language organizations that offer interpreters on the web or in

person (Kumar, 2016). Today, many healthcare organization utilize language interpreters over

the phone or in-person interpreters in the healthcare field; however, this is a very expensive and

challenging barrier that most people go thru because of the limited languages people currently

speak around the United States.

6. Identify the style. Which style of conflict resolution will you use in this situation?
Accommodating
Avoiding
Collaborating
Competing
Compromising
Accommodating is one style in managing conflict that is the most passive conflict

resolution. The style is known to accommodate the needs of others but may find that they are

unable to achieve an outcome that is acceptable or appropriate to them. As it may decrease the

chance of resulting to permanently solving the problem.

Another passive approach is the style of avoidance when managing a conflict. This

approach is utilized when individuals tend to accept decisions of resolutions without further

questions in order to avoid confrontation, immediate and difficult decisions or responsibilities.

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Although the style of avoidance is not as effective, it has its benefits as it can potentially solve

the issue on its own.

The style of collaborating involves all parties to aim a win-win solution. Such an

approach is essential when conflicts do not seek a solution in an urgent matter, in addition, the

conflict may involve many individuals across all levels of the organization.

The competing style of conflict resolution can be potentially seen as aggressive with an

individual who appears to take the “firmest stand” while causing others to feel involved or taken

advantage during the conflict.

Lastly, compromising style of conflict resolution involves each individual person to

contribute towards a conflict resolution and working together as a team. A solution will then be

resolved sooner than expected.

Upon identifying the various styles of conflict resolution, our chosen style that we would

like to utilize in this situation would be to collaborate with the healthcare team and with the

patient. The organization should have collaborated with their healthcare professional team to

make sure they took care of the patient and also collaborated with the patient would be to utilize

the team effectively. For example, the case study mentioned that there was on therapist who

spoke fluent Spanish should have offered interpretations to Emilio during his treatment process

to not only effectively offer treatment but to make sure that he is doing well. During the

assessment Emilio was unable to see whether his treatment was truly effective since he stopped

participating throughout the end of his treatment. I am concerned that there was not enough

collaboration with the entire healthcare professionals that Emilio worked with. Offering the

patient’s language capacity would eliminate the confusion the healthcare workers spoke about

the patient during his treatment process because we are unsure what was going on throughout his
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stay whether he was happy or if there were any issues. How can they know whether his treatment

was becoming successful when they were unable to speak with him effectively? Communicating

is the most important part of healthcare and this case study, unfortunately, lacked in that which

did not offer the best patient-centered care that healthcare wants to offer to their patients.

Conflict Management Style Narrative

Now, with your team, provide a narrative that outlines how you will use this particular conflict
management style to work your way through this scenario. Your narrative should be at least one
page long. Please incorporate the relational, emotional, communication-related, and empathic
practices that you have explored in the course.

When utilizing a particular conflict management style to this current scenario, it is

critical for the team to understand the mechanics of effective conflict management to navigate

arguments or disagreements among others with competence and care. For instance, when

utilizing the collaborative conflict management style, this style is to seek solutions that can

potentially satisfy both or all parties. Collaborative teamwork among healthcare professionals are

known to collaboratively work together, formulating decisions, sharing responsibilities, lead a

team to continue the improvement in decision making, while other healthcare professionals assist

in increasing other team member’s awareness of their skills and knowledge. To perform

effectively in clinical practice, it has been shown that good communication encourages

collaborative effort in order to prevent or avoid potential errors from occurring. By addressing
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the issue with good communication skills through collaborative work will create an opportunity

to enhance clinical outcomes.

A conflict management style the team should have utilized was collaboration with the

healthcare professionals and with the patient’s need is a high importance especially in the

healthcare field (Mossanen, 2014). Patients have difficulty communicating with healthcare

providers during their most critical care and in this situation Emilio was in that type of situation.

Emilio is a ethnic minority that is fluent in Spanish and limited in the english language. Conflict

occurs when there are difference with language and the healthcare professionals want to offer the

best medical care; however, patients typically want a holistic approach where they can receive

information and make sure that they get to participate in the critical moments of their time (Van

Keer, 2015). Emilio not only was suffered from a traumatic brain injury, but he was also

nonverbal due to a complex medical reason as well as the communication barrier. Emilio was in

a critical medical condition and this situation was relationally challenging for the healthcare

professionals due to the language barrier and his medical situation that resulted in the most need

for communication with a family member. Although the Aunt tried her best to offer assistance by

being proactively visiting the treatment center and offering support to the patient there was a lack

of communication where there seems to be conflict and confusion.

Communication with the aunt between healthcare professionals may be challenging, but

at the same time they should have offered effective communication rather than hindering to

speak with the aunt in regards to Emilios situation. There were also conflicts around healthcare

professionals where they all decided not to assist the patient to the fullest because they couldn’t

understand his language nor why he was acting differently during the end of the treatment.

Rather trying to communicate effectively with the patient they lacked in communication skills
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and their own professional judgement to offer suggestions that can potentially offer the highest

quality of care to the patient.

The hospital should have been trained on offering all patients language capacity the best

they can and offer communication support and recognize everybodies differences.

Communication is one thing, but to understand medical jargon is another issue that people deal

with. Hospital staff should have been more knowledgeable on how they could overcome these

communication challenges and conflicts by asking assistance with other team members who

spoke spanish fluently to make sure that they are aware how the patient is feeling and if there

were any medical issues his dealing with (Van Keer, 2015). The root cause of why Emilio had

difficulties and didn’t seem to wanting to socialize with other patients since he couldn’t speak

english fluently nor could other patients speak spanish fluently. Was he really being distracted

and uncooperative or did he have other issues in mind?

The caseworker should collaborate with healthcare professionals and with the patient

Emilio to make sure they understand his decision on whether he can stay at the Inpatient

treatment center versus going back home. In this case the case worker should get an interpreter to

offer the spanish language to see how Emilio feels and then if at any given chance Emilio can no

longer make his own decisions the aunt can decide to him to go home or not. This will eliminate

any conflict and other situations healthcare professionals are unaware of. The healthcare

professionals should not make assumptions of what the patient’s decision should be. This will

offer empathy to listen to the patients will then speaking with the family members with the

patient’s decisions to allow the aunt to understand what is occurring and what’s best for the

patient especially since there may be language barrier and poor understanding of Emilio’s

current medical condition.

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Follow-Up Questions

1. What cultural and communication factors do you need to take into consideration when
selecting an appropriate conflict management strategy?

Everybody comes from different cultures and communication styles so how do you

approach these types of situations when it’ll be different for another individual. First and

foremost, healthcare professionals should be aware that each and every individual comes from

different models of life and their communication methods differ. This way the healthcare

provider can understand the situation and diagnose the issue that they have which may require

different types of intervention skills (Zuker, 2014). One type of approach that can be used if to

let the patient speak and understand where they are coming from despite challenges. Second they

should be able to understand the patients differences and also communicate healthcare treatment

any differences. Third would be helpful to come to an agreement by working together. Fourth

once an agreement is made then you’ll able to satisfy by sides the patient and the healthcare

team. Fifth would be to manage conflict by creating an intervention that works for both parties.

Lastly communicate constantly to make sure that the results driven are the results the patients
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want and the healthcare providers are aware that they are in progress of making a difference to

the patient’s lives.

2. How might cultural differences be confused with other physical, cognitive, communicative,
or environmental characteristics in this case?

In this case, there was a language barrier, potential education barrier, financial barrier,

and also lack of close relatives such as a direct parent that was in the situation. In this case the

healthcare professionals only thought to themselves without collaborating with each other to

eliminate the language barrier they were having instead they blamed the patient Emilio that he

was being unsocial, but rather there may have been environmental differences Emilio was unable

to comprehend due to his medical diagnosis of traumatic brain injury and perhaps changes that

he was beginning to feel yet unable to express.

3. What do you see as the role of the patient’s aunt in your conflict management strategy?

She seemed like she was competing with the patient Emilio. The reason I state that is

because she didn’t seem to acknowledge what Emilio’s thoughts were nor did the healthcare

professionals thoughts. We are unsure whether she spoke with Emilio to find if he wanted to go

home or whether it was the aunt’s thought and that’s why I pick competing due to her

aggressiveness in wanting to take Emilio home.

4. Why did your team feel that this conflict resolution style was the best approach for this
situation?

Collaborating the conflict that the healthcare professionals had with the patient should

have been an immediate strategy they could have considered. The reason collaboration is

important is to develop an intervention plan that works best for the patient. Each and every
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patient is different and the approach they took by just ignoring the language barrier is a no-no. I

felt as if the healthcare professionals in their positions should have known better that his

diagnosis was Traumatic Brain Injury and he also had a language barrier - only able to speak

spanish fluently should have been considered. They should have offered spanish with all

healthcare professionals to eliminate any confusion and offered the best quality care they could

offer.

5. How did you utilize emotional intelligence during your conflict resolution negotiations?
Emotional intelligence is to capture and understand where the patient is coming from

despite their differences during a conflict. Emotional intelligence acknowledges each individuals

differences, but still maintains that strong link to offer the best care during any type of conflict.

During the conflict resolution, collaboration was a number one belief that we had that can help

the patient cope with the situation. Not only where the healthcare professionals all avoiding to

help this patient, but the patient himself had no control over the situation. Emilio was not part of

it, but yet the healthcare professionals blamed him in the end for not participating and being

unsocial. Yet there was no empathy or emotions in place of healthcare providers.

6. Describe the collaboration and negotiations that your team went through while working on a
resolution to this scenario.

During the resolution scenario it was pretty clear on what type of conflict strategy we

should have used in this scene where there was a lack of communication and empathy

throughout the entire case study. We made sure that we first communicated how we felt about

the study then we expressed what should have been eliminated and what should be best used for

this conflict management style pick. Collaboration was what we decided on.
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References:

Kumar, A., & Maskara, S. (2016). Overcoming language barrier in healthcare settings using
information and communication technologies. Saudi Medical Journal, 37(3), 328.
http://doi.org/10.15537/smj.2016.3.13706

Levit, L., Balogh, E., Nass, S. (2013). Committee on Improving the Quality of Cancer Care:
Addressing the Challenges of an Aging Population; Board on Health Care Services;
Institute of Medicine; Delivering High-Quality Cancer Care: Charting a New Course for
a System in Crisis. Washington (DC): National Academies Press (US); 3,
Patient-Centered Communication and Shared Decision Making.Available from:
https://www.ncbi.nlm.nih.gov/books/NBK202146/

Meuter, R. F., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015). Overcoming
language barriers in healthcare: A protocol for investigating safe and effective
communication when patients or clinicians use a second language. BMC health services
research, 15(1), 371.

Mossanen, M., Johnston, S. S., Green, J., & Joyner, B. D. (2014). A Practical Approach to
Conflict Management for Program Directors. Journal of Graduate Medical Education,
6(2), 345–346. http://doi.org/10.4300/JGME-D-14-00175.1

O’Daniel, M., & Rosenstein, A. H. (2008). Professional communication and team collaboration.

Schyve, P. M. (2007). Language differences as a barrier to quality and safety in health care: the
Joint Commission perspective. Journal of general internal medicine, 22(2), 360-361.

Van Keer, R.-L., Deschepper, R., Francke, A. L., Huyghens, L., & Bilsen, J. (2015). Conflicts
between healthcare professionals and families of a multi-ethnic patient population during
critical care: an ethnographic study. Critical Care, 19, 441.
http://doi.org/10.1186/s13054-015-1158-4
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Zucker, D. (2012). Tools for Productively Managing Conflict. Journal of Investigative Medicine 
:The Official Publication of the American Federation for Clinical Research, 60(5),
776–778 http://doi.org/10.231/JIM.0b013e31824e9828