How Physicians Can Move Physician Colleagues to Action

The more partners in a physician-owned practice, the more difficult it can be to address problems with practice operations and staff. As a result, nothing is ever remediated or resolved; revenues are lower than they should be; costs are higher; and frustration is constant.

Inability to enhance or correct the status quo often occurs when:

1. The partners are dissatisfied with different things. As a result, no single issue commands enough attention to compel action.

2. The partners share the same set of concerns, but they prioritize them differently. This situation can be hard to identify. All of the partners complaining about the same things gives the impression of unanimity, even in the absence of consensus on what should be addressed.

3. At least some of the dysfunction serves the interests of one or more partners. Their unstated, and possibly unrealized, goal is to block action. These are the partners who always want to examine more options, expand the scope, prolong discussion, postpone decisions, poke holes in planned solutions without offering alternatives, and are especially opposed to any outlays of cash.

Breaking the impasse requires at least one of the partners to assume the following roles:

1. Champion. The champion is the partner who is most committed to making things better for the practice as a whole. She must be willing to take a mid- to long-term view, letting others' priorities take precedence in the short-run in order to achieve her long-term objectives.

2. Mediator. A fortunate champion may be able to delegate some of the mediation work to another partner, the practice administrator, or a consultant. Depending upon partner relationships, delegation may be required. Mediation has three primary functions: fact-finding, analysis, and negotiation.

• Fact finding. The mediator's first task is to learn the objectives and priorities of each partner, paying special attention to lines in the sand.

• Analysis. The next step is to analyze the findings to identify promising first steps, as well as tradeoffs that have bargaining chip potential.

• Negotiation. The purpose of negotiation is to define an objective that all of the partners can support. Unanimous support is not the same thing as total agreement or even consensus, but it does require commitment to action on the objective. Support is often tendered in return for a promise unrelated to the particular project.

Different partners engage as champions and mediators in different situations, according to their interests and priorities.

Neither of these roles is easy or appealing to any physician who is already feeling overloaded and just wants to take care of patients. The only reason a partner ever assumes them is that the current situation is untenable or unsustainable, or he has a vision of an improved future.

The good news is that effectively addressing issues with practice operations and staff can quickly become standard operating procedure for a practice. All it takes is a couple of successful initiatives. Then, the time previously spent fretting and complaining is diverted to manifesting constructive solutions.