Addressing Medical Practice Staff Conflict

Aamer Hayat, chief operating officer at Avecinia Wellness Center, a two-physician family medicine/internal medicine practice in Clovis, Calif., is no stranger to staff conflict. Small tensions arise among his 12 staff members, he says, on an almost daily basis. But unlike in many other practices, those tiffs rarely escalate into full-blown crises.

"I see conflict as a failure in communication," says Hayat, who estimates large problems due to staff conflict crop up only once or twice each year in his practice. "...We believe in a total transparency model."

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That model, in which Hayat shares the practice's goals, financials, challenges, and opportunities openly with staff, and in which he encourages staff input and involvement, helps keep everyone on the same page and prevents small tensions from escalating. "It's out in the open," says Hayat "If at any time I or somebody else starts noticing there's a little [problem between staff members] ... I like to carry that transparency over and say, 'Hey, you know what, let's get the two people in the same room.'" Often, he says, simply sitting down with the conflicting parties and facilitating a discussion eases the tension.

Hayat's approach to preventing and addressing staff conflict is a smart one, say experts. And it's one that most medical practice managers might benefit from emulating. While Hayat's staff rarely gets into large-scale, time-consuming disagreements, most managers are not so lucky. A 2008 report published by research firm CCP, Inc., which produces the Myers-Briggs Type Indicator personality assessment tool, found that most employees in American businesses spend almost three hours per week dealing with conflict. The report, "Workplace Conflict and How Businesses Can Harvest It to Thrive," also found that while 85 percent of workers say they deal with workplace conflict, only 22 percent say their managers deal with it well.

That percentage would not surprise Charlie Hauck, president and lead trainer at Growth Dynamics, a consulting company specializing in the selection and development of human capital and strategic planning. "Managers, in most practices, bring something other than people skills to the table as their primary reason for getting hired," says Hauck. "They may be really good at office management on a technical or a fiscal side, but very few managers in healthcare have ever been trained to deal with people challenges."

To help address that training gap and ensure you are prepared to manage conflict appropriately at your practice, we asked Hauck and other experts to weigh in. Here's what they say are some of the best ways to prevent conflict from cropping up, and how to address it when it does occur.

The first step to preventing conflict is making it clear to staff members that it will not be tolerated. Take time to discuss your expectations regarding professionalism with your staff, and specifically, point out that conflict and behaviors that lead to it, such as gossip, are unacceptable, says Vivian Scott, a certified mediator and president of Vivian Scott Mediation, LLC. Moving forward, discuss these professional standards during every new employee's onboarding process.

Also, make your expectations regarding performance and workplace culture clear to staff, such as what time they need to arrive, how they must accomplish certain tasks, and how they should communicate with each other. When these expectations are clearly defined, it will reduce the likelihood that conflicts will arise because employees are not on the same page, says Hauck. For instance, if one employee's definition of being "on time" is getting in the front door at 9 a.m. on the dot, and another's is sitting at his desk ready to work at 9 a.m., the employee who arrives earlier than the other employee may begin to build up resentment toward the other staff member. "This goes back to clearly defining the expectations of exceptional performance," says Hauck. " ... Consistency cures a lot of the things that we're talking about here."

Be aware of the common sources of staff conflict, and do your best to avoid them. One is personality differences, and/or work style variations. Some personalities thrive when they can interact with others frequently, for instance, while others need quiet work environments. And while some individuals are more dogmatic and focused, others prefer jumping around from task to task.

To prevent tensions from arising due to these types of differences, ensure that your staff understands and respects their varying approaches to work, says Beth Brascugli De Lima, principal and founder of human resources consulting firm HRM Consulting, Inc. She recommends conducting (or hiring a consultant to help you conduct) employee work style and/or personality evaluations. Then, use the evaluations to educate staff about their differences. "Train individuals that we have different personality types and it's not personal," she says. "In other words, the fact that you might be a more social person and I might be a more technical person doesn't mean that I am trying to do anything to you, or force you to do it my way. We have different ways that we work, and we have to understand that it's OK to work differently as long as the job gets done."

Identifying work style and personality differences can also help guide future hiring, if perhaps you are trying to find the right fit for a particular department or team. "You can find out if you already have a 'bold' person and you've got a 'technical' person, and you need someone who's more empathetic or sympathetic," says De Lima. "It's really functional to have all the pieces of these different personality types on your team because you have a more well-rounded team."

Another way to ease tensions that might arise due to work style or personality differences is by encouraging, as Hayat does, open communication. If staff members feel comfortable discussing their smaller gripes and annoyances with each other, and they do so in a professional and polite manner, it's less likely those small issues will escalate into big altercations, says Jamie Claypool, president of practice management consulting firm J. Claypool Associates.

She recently consulted in a practice where there was a significant age gap between the two front-desk staffers. Tensions arose because the younger woman felt comfortable openly discussing her personal life, while the older woman felt this was inappropriate. "Those kinds of things, in the older lady's generation, are things you don't discuss, period," says Claypool. "You don't take them to work ..."

If the older woman had sat down with the younger woman to discuss her feelings, it may have led to a much healthier environment, in which the two staffers could work together more comfortably. "You see practices that rarely have conflict, and I think the big difference is communication," Claypool says. "They're able to embrace their differences, and they're able to communicate about what's annoying in a professional and rational way."

Another common source of tension in practices is favoritism (or perceived favoritism) between staff members, such as when cliques form and one staff member is left out; or between staff members and practice leadership, such as when a physician treats his nurse differently than the others. "It creates a double standard, and it creates a sense of unfairness, and it creates a sense of inferiority on the members that are not getting preferential treatment," says Claypool.

She recommends cultivating a no-favoritism culture at your practice by addressing it with leadership as soon as you see it occur. Pull the individual aside, provide examples of where he has shown favoritism, and discuss some of the consequences, she says.

Favoritism between staff, such as a group of nurses that excludes a colleague, also causes tension. Again, Claypool recommends meeting with the individuals involved privately to discuss their exclusive behavior and explain why it is inappropriate. In many cases, she says, this discussion alone will solve the problem. "People sometimes don't even know that they are [displaying favoritism]," she says.

Despite your best efforts to prevent and ease tensions, serious conflicts may occur. Make sure you have a plan ready so that you can handle such problems quickly and appropriately.

Whatever you do, don't procrastinate when it comes to addressing conflict, says Donna Weinstock, president of Office Management Solution, a practice consulting firm. "If behaviors like that fester, they just go on and it makes it more difficult [to resolve them]," she says.

Addressing conflicts quickly can also prevent bigger headaches down the road, says De Lima. "If there is something going on, there may be an underlying issue that could be [in violation of] a federal or state regulation," she says. "Maybe there is an affair going on and that's why the favoritism is happening ... Those kinds of things are so litigious that if you don't take everything seriously and get at the bottom of the issue, you won't uncover if there is that kind of a problem going on."

As part of your conflict resolution plan, De Lima recommends creating a "performance management system" that includes policies addressing professionalism in the workplace, a code of conduct, a counseling form to use when conflicts occur, and an open-door grievance or complaint procedure. The grievance procedure should include a "well-thought out" investigation process so that leadership knows how to handle problems in a consistent manner (such as what questions to ask the relevant parties). That way staff will not perceive the investigator as biased, says De Lima.

While addressing conflict immediately is important, so is addressing it the right way. That's where the counseling form comes in. De Lima recommends meeting with the individuals involved in the conflict privately, and providing them with a form that notes your concerns, and provides examples of the problem behavior. "The counseling form lets them know what policy they are violating, why they are violating it; and gives them specific examples including dates, times, actual words said, actual behaviors observed," she says. " ...Without giving them specific words that were used, the date and time it occurred ... you're not having much of an impact."

In addition to indicating that the conflict or the behavior leading to it is unacceptable, the counseling form will help protect you if you determine that you need to terminate an employee as a result, says De Lima. "The most exposure that organizations have is not choosing to formally document problems in the workplace that are violating policies and procedures, and instead having an informal conversation," she says. "With human resources, documentation is everything. You always document everything but you do it in an appropriate, objective way. Not my opinion, but what I saw, heard, [and] confirmed."

When meeting with the individuals involved in the conflict, ask them to explain - from their perspective - the root of the problem, says De Lima. "Get the 'real' story from everybody, document it carefully, and if there are discrepancies, try and identify why one person is saying one thing and one person is saying another."

Once you've met privately with each individual, Claypool recommends holding a joint discussion. Often, simply encouraging the individuals to talk things through will help ease tensions. "I can't give you a surefire resolution for all types of conflict, but if people just would be made to have a personal discussion and allow the conflict to come out in the open, and tell each other how they feel about this type of behavior, it would work itself out better rather than to just kind of keep it to yourself," says Claypool. "Polite professional confrontation about the conflict on both sides is what we like to see."

During the joint discussion, Hauck says the manager should make it clear that the staff members involved need to solve the problem on their own. For instance, ask them to work together to come up with a resolution plan, and write it down. "When you force the people with the conflict to write a mutual prescription, they'll take their own medicine before they'll take yours," says Hauck. "A manager shouldn't be a prescriptive manager; [he] should be a facilitative manager."

If you find that the staffers are having trouble making progress, prompt them with open-ended questions, and praise them when appropriate, says Scott.

If you determine, from the initial complaints or concerns, that the conflict may be related to a state or federal violation of harassment, discrimination, or retaliation, you must initiate an unbiased investigation into the matter, says De Lima. This may require relocating one of the individuals to a different department, or shifting their work during the course of the investigation so the employees are not forced to continue working together. The most important thing, she says, is to not ignore apparent reported conflicts in the workplace. "You want to get to the bottom of these issues and address them effectively to prevent a more serious problem from occurring, such as a lawsuit."

If you find that the conflict is based on an issue that does not violate any state or federal discrimination or harassment regulations, make it clear that the staff members may face significant consequences if they do not resolve the issue, says De Lima. "Let them know that this isn't going to be tolerated, and whoever doesn't change their behavior will be gone," she says. "If the two of them cannot change their behavior in the workplace together, they will both be gone."

When necessary, don't hesitate to follow through with those warnings. The worst thing you can do, says Claypool, is fail to let staff go when necessary. The rest of your staff will see you as ineffectual, your best staff members may choose to leave for a healthier workplace, and you may struggle to recruit and retain great staff in the future. "I have seen staff conflict injure practices from a recruitment standpoint," says Claypool. "You get the swinging door with people coming in and out and the practice gets a bad reputation."

Aubrey Westgate is senior editor for Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

Don't let staff conflict harm your practice. Here's how to keep it from spiraling out of control:

• Encourage staff to have open and professional discussions about small annoyances

Want more tips on resolving conflict among medical practice staff? Take 15 minutes to view a presentation by Charlie Hauck of Growth Dynamics, who offers tips and strategies to reduce disputes in your office. To view the presentation, visit bit.ly/resolve-staff-conflict.

This article originally appeared in the October 2014 issue of Physicians Practice.