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Head off conflict
at the pass
- Act quickly. The sooner you
move to resolve the conflict the better.
- Get the facts. Talk to the
parties concerned directly. Don't rely on others
to give you their version of what happened.
- Practise containment. Don't
let the conflict spread to others in the office.
- Set the context. Consider
the conflict within the overall goals of the
practice and the values it represents both inside
and to patients, hospital and suppliers.
- Show respect. Without impartiality
there can be no resolution.
- Listen, listen, listen. And
make it clear to each party that you hear what
they're saying.
- Look for compromises. Most
conflict resolutions require each party to move
toward the other's position. Giving a little
to help the overall good should not be viewed
as failure.
- Come to a quick resolution.
Time may heal all wounds but busy practices
don't have that luxury. Do everything you can
and then invoke closure.
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No group practice runs smoothly
all the time. An eight-doctor multispecialty group in
the Delta region south of Vancouver would have disputed
that — until last June. For 11 years the group, which
includes many patients new to Canada, had run like clockwork.
There were the usual complaints: too many patients, too
little time, but the partners had no significant conflicts.
The group had started as a three-physician
practice and had gradually grown to its present size.
Four years ago they built and moved into a new facility
all with a remarkable degree of cooperation. Then, last
March, they took on a new physician who had originally
trained in India and had finished his studies in Britain
and begun practice there.
GO
WEST YOUNG DOC
He moved to Vancouver at the urgings of his wife's family
who had settled there. He'd been frustrated with what
he considered undue delays in qualifying for practice
in BC and was apparently grateful for the opportunity
to join the group. The group felt he'd be a real asset
given the patient mix and, particularly, that he would
relieve the pressure on other members who struggled
to cope with the burgeoning practice.
It wasn't a great beginning. The
new doctor fussed about the location and size of his
office — as the junior he received what might have
been considered the worst office though they were all
about the same, give or take a square metre or two.
He complained that his faced the parking lot. He was
also dissatisfied with the quality of the office furniture.
Though this had never been an issue before, the group
office manager suggested that they give him a furniture
allowance and let him furnish his office as he wished,
paying for any difference out of his own pocket. This
he did with the result that his was the most luxuriously
equipped office of any. His father-in-law was in the
office furniture business and gave him excellent prices,
he told his colleagues.
The fuss over the furniture meant
that an extra 10 days went by before he began to see
patients. Once he did, it was immediately apparent that
he worked at a more leisurely pace than did other group
members. Patient-visits took an average of 15 minutes
with the other group members; his sometimes went on
20, even 30 minutes. The backlog created havoc in the
appointment system and the shared reception area soon
filled up with patients waiting to see the new man.
The issue was entirely unexpected
by the group and there was no mechanism for dealing
with it. At the end of the second week, the senior doctor
took him aside and laid down the law. This was a busy
practice and he wasn't pulling his weight. The new physician
countered that since they shared expenses (not revenue)
and that he had every intention of meeting his financial
obligations to the group it was nobody's business but
his own whether he saw eight patients a day or 80. The
senior ended the discussion by demanding that he leave
his office at once.
The conflict continued to escalate.
With no obvious way out, the group simply tried to ignore
it hoping that somehow he'd come around. By July, the
two sides were at an impasse. Though the new doctor
had indeed met his monthly financial obligations, he
was dissatisfied with his after-expense earnings, not
surprisingly. "See more patients," he was advised. Instead,
he circulated an article that contrasted the British
system of medicine with the Canadian. UK GPs, the article
suggested, worked a 40-hour-week, were paid extra for
on-call duties and, in afterhours cases, were provided
free transportation to and from the hospital. Moreover,
said the paper, they had four weeks' paid vacation a
year and earned twice as much (when converted to Canadian
dollars) as did general practitioners here.
Fuming, the senior doctor called
a group meeting to which the dissenter wasn't invited.
It was decided in short order that the situation was
out of hand and that the group didn't have the internal
resources to handle it. The practice lawyer was called
and he suggested a mediator. Reluctantly, the group
agreed and, in July, the mediator held the first meeting
attended by the senior physician and new group member.
Intended to last only an hour and be the first of several
such discussions, the session went well into the evening.
By the time it ended, the new doctor had agreed to leave
the group. He was given three months in which to find
another position. By mid-September he was gone and a
replacement found. The latest group member was given
a folder, prepared by the lawyer. It contained a history
of the group; the partnership arrangements clearly written
out in plain language; a newly drafted regulation regarding
furniture and equipment; and a thorough job description
including required patient volumes.
DOCTOR/STAFF
CONFLICTS
Doctor to doctor conflicts can tear a practice apart.
Doctor/staff eruptions can be almost as damaging. Take
the following case. A staffer whom we'll call Cheryl
made rapid progress in a big group in Winnipeg. She
was bright, personable, a quick study and a close friend
of the office manager who hired her straight out of
secretarial school. She began as a file clerk; moved
up to handle government and third party billings; was
put in charge of updating the group's computer system;
and, in a remarkably short time, was appointed assistant
manager. She was just 24-years-old. So far, so good.
She got along well with the rest
of the staff — despite a reputation of being something
of a teacher's pet — and the doctors recognized
her intelligence and considered her ability to learn
quickly and to adapt to new situations to be a strong
asset. There was one exception. A senior cardiologist
felt that she had come too far, too fast; that her grasp
of her work was superficial; and that she was a little
too sure of herself for his liking. Still, her work
ethic was beyond question and she clearly had the ability
to get things done. All might have been fine had the
office manager not become pregnant. One month before
the baby was due the assistant took over the manager's
job for a period that was expected to last a full 12
months.
Within a week she and the specialist
clashed. "I like to have all the files of the patients
I'm to see in a given week on my desk first thing Monday
morning. And I like them to stay there until the close
of practice on Friday. Is that too much to ask?" he
complained at the first group meeting to be held after
her appointment. "Apparently it is," he continued, answering
his own question. "She's decided files will be delivered
each morning and returned to the files each evening.
I told her that wouldn't do. She had the impudence to
tell me, 'Try it for a week, doctor, I'm sure you're
going to like it.' And waltzed out of my office."
Despite the fact that the change
had been okayed by the group at a previous meeting he'd
missed, he continued to feel that the employee was out
of bounds. For the next several weeks, he complained
about her at every meeting. She didn't listen. She didn't
follow through. She forgot things. She lorded it over
other staff members. It was intolerable.
Finally, the lead physician decided
he had to step in. He first had a private chat with
the cardiologist and then spoke privately with the assistant
manager. Both were strong personalities and stuck to
their guns, insisting that the other was to blame for
their trouble. A third meeting with both attending was
unable to break the deadlock. The following day, the
assistant submitted her resignation. It was accepted
with regret. The regular manager didn't return at the
end of her pregnancy leave and the practice went through
a tough 18 months before they were able to find a good
replacement.
Moral: Learn to spot conflicts
as early as possible. Be especially sensitive to those
between physicians and staff. The inequality in the
power position of each can be explosive. For more, see
the accompanying side bar, "Head off conflict at the
pass."
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