Dealing with Staff Conflict

Something felt constantly off course at the Cincinnati ophthalmology practice where Jessica Graves is the clinical operations manager. She describes the discord witnessed between front- and back-office staff. "There seemed to be ongoing, underlying resentment between the teams that started with incidents between individuals and then spread to a crisis level. It impacted whole sections of staff and even patients."

A typical practice setting brings together a variety of expertise and personalities. Like an orchestral symphony, there are distinct parts to be played - in unison and with occasional solos - that, when performed well, result in a thriving healthcare delivery business. Like a conductor, someone in every practice is assigned the crucial task of directing multi-talented staff to play their parts optimally and as a team.

"It holds true for any business: If you know you're not cut out for a task (for example, resolving tough staff conflicts), you hire or assign someone on staff who is well versed and enjoys that role," says Vivian Scott, author of "Conflict Resolution at Work For Dummies" and a certified mediator.

Occasional discordant harmony may flavor musical performances, but in a medical practice, the result of staff being out of tune or out of sync with each other can be costly. Staff conflicts can generate a cascade of negative feelings and events with the potential of ruining your business.

Charlie Hauck, president of Growth Dynamics, a consulting firm that assists with the selection, development, and retention of staff, sums up the possible end result of unaddressed staff conflicts: "The impacts can reach far and wide: lawsuits, loss of good employees, costs to replace employees, patient care disruption. Efficiency breaks down, communication stops, revenue decreases, and eventually, the practice loses patients."

For Graves, tensions between front- and back-office staff at the 45-physician, multi-location practice grew to the point of being responsible for staff shortages. "I had employees who didn't want to come in to work or would refuse to go on the floor with other staff members, and this meant I had to pull from other resources in an unplanned way."

Some level of disagreement is natural in any team effort. However, according to Scott, workplace statistics reveal 85 percent of employees report having dealt with on-the-job conflict (greater than petty differences), and staff in such settings spend an average of nearly three hours a week in related, unproductive paid time.

You can take steps toward returning harmony to your practice, as well as coordinate hiring, assignments, and logistics to avoid staff discord in the first place.

Restoring harmony

In the case of recurring front-back office tensions at the ophthalmology practice, Graves found key differences in opinion about their team's value. "Administrative and clinical staff may have misconceptions about the worth of their roles to the practice," she says. "Each team can have moments of feeling undervalued. Occasionally, the opposite happens as well. A team can behave as if, without them, the whole practice would crumble. I've had staff apply for transfer to a different team because they think they understand a particular physician's style, and a power struggle results."

Generally, Graves believes in first talking with the individuals involved, before calling a group meeting to discuss problematic issues. Before holding such meetings, she arrives at a decision about improving operations and gets the key players on board before presenting to the entire team. A review date is also designated on the calendar to reassess the problem in the future.

Even crisis-level eruptions can sometimes be boiled down to causes as simple as inadequate space for performing tasks, although the drama of simmering emotions can hide the potentially easier-to-rectify challenges of office layout or shift scheduling.

Although Graves has seen issues arise due to nonpersonal conflicts, she says the clinic's most recent difficulties were more personality-oriented. "In those cases, I assigned some individualized peer-to-peer work and presented it in a team setting so no one really felt singled out, which I felt they all would if we had conducted individual meetings."

From her mediation practice experience, Scott says if a disagreement becomes a recurring dispute, it's time to get outside help. That help may be in the form of a consultant or human resource tools administered internally.

Eight years ago, Bloomington Hospital in Indiana instituted the use of the Predictive Index (PI), a simple questionnaire that provides insight into a person's workplace behaviors and motivations. In addition to screening prospective employees, the instrument is used in cases of staff conflict.

Bruce Wade, director of human resources at Bloomington, explains: "Using a quick-format questionnaire has depersonalized the resolution process, which might otherwise be steered by heated emotions into more crises. The PI helps employees gain a better handle on what makes them tick, then we can all work together to arrive at consensus about amending situations for the better."

Setting the stage for accord

Scott describes two equally important "first steps" toward lining up the elements for a productive, peaceful practice.

"I encourage every workplace to have a written code of conduct with something akin to an agreement that if I have a problem with you, I'll come to you. If we can't resolve it, I'll go to the assigned practice administrator," Scott says. The key is having every staff member knowledgeable about this code, upfront. "This puts the responsibility squarely on everyone's shoulders to watch for and manage conflict early," she says.

The concurrent step is to have someone clearly defined as the go-to person for unresolved problems. In small practices, that may be the physician or, as in Graves' case, another staff member functioning as operations manager. In choosing employees for that pivotal role, Scott says you want an individual with "genuine curiosity, who sees conflict as an opportunity to make the practice better." Are there "types" of people who would make especially poor conflict managers? Scott says to be wary of handing the director's baton to individuals who view all problems as something to merely avoid or who think conflict is always people- or personality-centered.

Making more deliberate choices in hiring and task assignment is how Wade helps medical teams at Bloomington Hospital start off on the right note. Every prospective employee completes the Predictive Index; giving the human resources staff an understandable description of complex personality traits.

Hauck echoes the fundamental significance of the hiring process and says when a practice sees frequent turnover resulting from staff disruptions, reactive hiring procedures and policies may be the cause.

"There are a number of tools and consultants that can steer hiring," Hauck advises. "The bottom line: don't hire a resume." He likens rushed hiring practices to inadequate diagnostic testing. "Using certain well-tuned methods to assess prospective employees may take longer than relying on intuition, even feelings gleaned from in-person interviews, but in the end, it costs far more to deal with a 'bad hire' after they've come on board."

Turning a deaf ear to trouble?

Is it ever helpful for a practice administrator or physician to allow staff conflicts to subside on their own, without being directly confronted?

"Absolutely!" Scott remarks, "There's no need to overreact to minor disagreements. However, if the disagreement turns into army-building, gossip, or work disruptions for more than a few days, it's time to address it."

Graves recommends viewing operations from a patient's perspective and listening closely to stay on top of potential problems. "Besides keeping in touch with each team's leader as a manager, I get out and keep a feel for the lobby and patient flow from time to time. I've found there's nothing more telling about the quality of service we provide, through the eyes and conversations of our patients."

Tracy Morris is a freelance writer based in Houston, Texas. She's been a writer and editor for healthcare industry publications and websites, as well as a consulting writer for practices ranging from solo physicians to national corporate networks. She is also a member of the Association of Health Care Journalists. She can be reached via editor@physicianspractice.com.

This article originally appeared in the September 2011 issue of Physicians Practice.