You Say You Want a Resolution?

December 15, 2017

Just because your group is generally peaceful doesn’t mean you’ve mastered conflict resolution, and it certainly doesn’t mean conflict won’t crop up in the future. Conflict isn’t a bad thing — it just is; If you don’t accept that, you can’t move beyond conflict and you’ll get stuck. That’s danger­ous because the more stuck we are, the less we can evolve and learn from each other.

Without a clear policy for dealing with group conflict, staff can

  • take sides
  • think about exacting revenge against the person who wronged them
  • decide to leave prematurely
  • act passive aggressively

When staff start behaving like this, you end up working against a unified vision and you are not perceived by others as a strong group.

Signs of conflict brewing

It’s easy to notice tension in a group riddled with conflict, but what about warning signs that war is coming? Watch for these three indications that conflict is brewing:

  • Assumptions. Staff members who would normally check and double-check information start to de­termine the meaning behind an unclear order based on whether they’re allied with the physician who gave the direction.
  • Rumors. If water-cooler talk shifts from the summer blockbusters to he-said she-said, your group may have trouble re­solving conflicts.
  • Turfing. You may start to notice that physicians refer patients dif­ferently, a practice known as turfing. Do doctors hold onto a patient even when another doctor has greater experience for that patient’s needs? Do doctors only re­fer their most difficult patients or patients that have the lowest reimbursement rate? Turfing is sometimes another way of exacting revenge and inflicting pain on the other side.

Take action

Ignoring warning signs won’t eliminate conflict. Chances are, the problem will get messier before it goes away. A good conflict-resolution policy can prevent muckraking that can come from unchecked conflict. When people are afraid of conflict, they procrastinate [about] dealing with a flare-up in the practice – But that allows things to escalate and it can have negatives outside the group too.

A competing practice that is unified will seem much more professional to patients. The group will not only retain the patients it has, but it may attract some of yours. They can be more innovative and be able to learn new techniques that the [your] group has not had any energy for because all [your] time is wasted in conflict.

Deal with conflict

Certainly conflict resolution is not a simple process that can be summarized in one article. However, you can be on your way to resolution with these three steps:

Recognize you have a problem.

Writing a conflict-resolution policy does nothing unless the staff and physicians in your office understand that it’s a tool that they can—and should—use. Ideally, the doctors or staff involved will have enough training in dispute settlement and conflict management that they’ll realize early on that there’s a conflict. Be­cause conflict resolution is about preserving the group, it’s important that your practice is clear that anyone in the office can initiate the process.

Work toward a solution internally.

Have a member of your staff—in a large group, this might be the department chief; in a small group, the office manager—sit down with the disputing parties to get to the bottom of the problem. Have the person in charge say, ‘I don’t like what I’m hearing.’

Consider bringing the conflicting staff members together and allowing each side to spell out their grievances including:

  • what each side understands to be the truth
  • what concerns their other colleagues have about the rift
  • how each side feels about the other

Invest in outside mediation.

Whether you hire a professional mediator or ask a group outside of your competition to mediate for you, an objective, nonjudgmental party can help you assess the reasons behind the conflict and develop a plan to resolve it.

Handle resistance

If, after going through your conflict-resolution process, the problem still exists, don’t hesitate to return for additional outside mediation. Make sure all parties understand the need for resolution. Teach them to look at their differences as learning opportunities.

For example, if the conflict is about treatment style, maybe the high-performing doctor can teach the doctor who takes more time with patients how to be more ef­ficient, while that doctor can teach the high-performing doctor the joy of getting to know a patient.

Also, make sure the doctors understand and own the beha­viors that contribute to the rift. Parties are less likely to hold grudges if they examine their be­havior and accept part of the responsibility.

If you still haven’t reached a resolution, consider asking the problem parties to leave the practice. Even though it’s uncomfortable to dismiss staff because of behavior, if you can document their actions are contrary to the mission of the group and you give them ample notice to find another position, you needn’t be too concerned about being sued.

Confronting a colleague and considering that they may have to leave or change some style or some behavior is as difficult as anything in medicine, if not the most difficult thing you’ll have to do in medicine. But don’t underestimate the consequences of keeping a disruptive physician or staff member.

I once consulted with an emergency medicine practice where three of the doctors left the practice because of control issues associated with a fourth one. If you’re too uncomfortable to fire the staff member yourself, hire a consultant to confront the employee with you.

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