Leading your team past the inevitable conflicts of practice life

A strong practice leader quickly and effectively reduces and resolves conflicts.

John B. Pinto

Whenever you’re in conflict with someone, there is one factor that can make the difference between damaging your relationship and deepening it. That factor is attitude.
– William James

Courage is what it takes to stand up and speak. Courage is also what it takes to sit down and listen.
– Winston Churchill

When leading others, even in the most genteel of practices, two simple truths apply that you need to master. First, conflicts will always occur, even among the kindest, best-intentioned individuals in a workgroup. And second, the excellence of your leadership is not measured by how few conflicts arise on your watch, but by how quickly and effectively these conflicts are reduced and resolved by you.

Practice conflicts have always been prominent when leading in this people-intensive arena. These conflicts issue from a host of innate personalities found in those who gravitate to medicine. The adverse behaviors flowing from these personalities are now being magnified in an environment of progressively tighter finances and sharply clearer threats to business survival.

However, in most clinic settings, conflict is not diffuse and generalized. We can often point to one thorn in your side who is an enduring wellspring of conflict. It is likely that some one person in your practice is your major annoyance and distraction to your leadership responsibilities. This can be a provider, a lay staff member or, increasingly, if you work in a health system or multi-specialty clinic, an institutional colleague or overseer.

We are all periodically a thorn, even the angels among us. Durable thorns are the greater challenge. The adverse impact of workplace thorns is magnified by leaders who fail to lay down strong rules or in settings in which roles are unclear and there are unintended signals sent to your office thorn that it is OK to buck authority and make others miserable.

Responsibility

In the same way that parents are responsible for calming family conflicts issuing from their children, it is the responsibility of the more senior practice leaders — owners and managers — to resolve conflicts occurring at lower levels. Just as an effective physician reveals a disease and applies the appropriate treatment briskly, the effective practice leader finds and fixes conflict without delay. Everyone involved in a conflict needs to be called into the room at the earliest possible moment. But unlike disease managers, business managers can be conflict-avoidant and uncertain about how to start the discussion.

In heated settings it can help to draw a conflict diagram to stimulate a group dialogue and to better understand who “owns” a conflict. Write down the involved parties; this may be a cohort of doctors or the members of a single department. Array the names at the corners of a triangle for three people, the corners of a square for four people and so forth. Then draw lines between each party and label each line based on your loosely judged objective paired scores for their present level of conflict between each person on a 1 (low) to 10 (high) level.

In the simple diagram shown below, Dave, Mike and Mary are three eye surgeons, partners in their group practice. Mike and Mary have a very low level of conflict — a 2, as marked on the diagram. Dave and Mike have a high level of conflict, an 8. Dave and Mary have an even stronger level of conflict, a 9.

Source: Pinto JB

It is a good hunch in this setting that Dave could be the source of the conflict. A diagram like this is especially useful when you have more than three parties and are trying to communicate with your practice’s thorn why you believe that they could be chiefly responsible for the difficulty.

Conflict resolution

Here are a few insights on conflict resolution from the writings of Richard Darlington, an eclectic British-Italian trade union negotiator, framed in an ophthalmic context (http://www.rogerdarlington.co.uk/conflict.html).

1. “Be calm. Conflict usually engenders strong emotions and even anger, but in such a state, you are unlikely to be particularly rational or in the mood for compromise.”

If two conflicting doctors are highly charged emotionally, take a time out and return to resolution efforts at another time.

2. “Always show respect. However much you disagree with someone, attack the argument, not the person.”

This approach can break down when dealing with individuals who are themselves disrespectful of the discussion process. In such situations, group pressure and removal of the offending party from a group discussion are the common resorts used by effective leaders.

3. “Discuss or debate. So often, conflict is created and/or maintained because there is no real discussion or debate. We make assumptions about the other person’s point of view and willingness to compromise, which might be quite wrong.”

In addition to discussing an issue verbally, diagram it on a whiteboard or yellow pad.

4. “Apply rationality. Much conflict is not about substance but perception. Try to clear through the perception to discover and agree on how things really are.”

Ophthalmology is a fact-laden enterprise; the management of an ophthalmic practice should be similarly factual and rational. Use benchmarks, industry standards and the documentation of the best demonstrated practices to agree on what is true before trying to hammer out disagreements.

5. “Change the wording. It’s amazing how often we disagree about words and how a change of words can change how people view a situation.”

Instead of criticizing a young associate for his low surgical volumes, invite him to set future growth goals, backed up by new outreach efforts.

6. “Change the environment. It’s no coincidence that some of the toughest political negotiations of all times, for instance those aimed at Middle East peace, often take place in locations like the Camp David presidential retreat.”

Do not hold tough board meetings in the staff lounge. Reserve a private dining room at everyone’s favorite restaurant or borrow your attorney’s board room.

7. “If absolutely necessary, apply authority.”

Conflict can sometimes only be resolved by one party imposing his or her authority as the administrator or managing partner. Such a “settlement” will cause resentment in the party at the receiving end, but sometimes this is the only way to resolve a conflict and move on.

8. “If all else fails, wait. Most problems change over time. Either the problem solves itself because circumstances change or one’s attitude about the problem changes as the heat dies down and other matters assume more prominence.”

• John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. He is the author of John Pinto’s Little Green Book of Ophthalmology; Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement; Cash Flow: The Practical Art of Earning More From Your Ophthalmology Practice; The Efficient Ophthalmologist: How to See More Patients, Provide Better Care and Prosper in an Era of Falling Fees; The Women of Ophthalmology; and his new book, Legal Issues in Ophthalmology: A Review for Surgeons and Administrators. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.

Voyage to EHR

OSN Practice Management Section Editor John B. Pinto has recently launched “Voyage to EHR,” a new project sponsored by Compulink Business Systems and Ocular Surgery News. This project will culminate in John’s month long solo sail from San Diego to Honolulu in a 24-foot boat starting May 6, 2012.

John’s voyage is meant to raise awareness of the similar “expedition” surgeons undertake when converting to electronic health records and will also support the work of the Hawaiian Eye Foundation.

To learn more about the foundation’s work and to make a donation supporting its eye care and surgical training services throughout the Pacific, please go to www.hawaiianeyefoundation.org.