How to shape positive relationships in medical practices and hospitals - Part 2: Conflict Management

Physician Executive, Sept-Oct, 1999 by Wayne M. Sotile, Mary O. Sotile

VERBAL ABUSE. SEXUAL harassment. Racial or ethnic slurs. Inappropriate entries in patient records. Noncompliance with practice or hospital policies. Vendettas against hospital administrators. Constant staff turnover. Bickering and unproductive competitiveness. Battles overpower, control, or professional turf.

Disruptive physicians. The problems they cause can threaten the viability of any medical organization. Policing the offenders is a necessary but far from sufficient response to this problem; larger organizational issues must also be addressed.

Managing disruptive physicians requires organization-wide interventions designed to both eliminate negative behaviors and foster positive interpersonal dynamics. The goal is to teach medical professionals how to replace negative interpersonal behaviors with those that are positive. For medical practices and hospital systems, this requires a combination of preventative and palliative strategies. The seven guidelines outlined in Table i can help to structure these efforts.

Seven steps to solving the disruptive physician problem

1. Provide protection

A clearly-stated code of conduct as well as policies and procedures for dealing with violations are prerequisites for developing a medical workplace that allows employees to function in a freer, more relaxed and productive manner. The key is to be proactive. If you wait to adopt a code of conduct in the wake of a complaint, the offending party is likely to perceive the policy as being a punitive, personal attack. (1)

No code can specify every possible violation, and any attempt to do so will be regarded as being overly dictatorial and insulting. In general, the code should flow logically from your organization's mission statement, and it should specify both blatantly unacceptable behaviors--like impairment from substance abuse or sexual harassment--and behaviors that can subtly damage your organization's morale, productivity, or reputation. (2) Table 2 lists examples of subtle behaviors that can undermine group cohesion.

When specifying a procedure for reporting inappropriate behavior:

* Make it easy and confidential. Your complaint system should be uncomplicated and should protect a complainant's privacy. (3) Unless staffers and doctors are trained in how to use the reporting process, it is useless.

* Give feedback promptly and regularly There is no quicker way to lose the trust and respect of the people you manage than to appear to be doing nothing in response to their complaints. At minimum, give the complainant a periodic update, even if it's simply to say, "We are not ignoring your complaint. I'm sorry that I can't say more. But please know that we are following through."

* Develop a special committee. A committee charged specifically with the task of overseeing interpersonal relations may be helpful. In hospitals, this committee is typically comprised of representatives from the boards of key medical groups, the hospital's physician executive, a person from human resources, and an attorney.

For medical groups, the levels of trust and conflict influence the structure of such a committee. If the group has a high level of trust and a low level of conflict, they may elect a committee of their own members. Often, this task is left to the group's executive committee or to the board of directors if it is small enough. However, consultants generally agree that if a group's executive committee or a hospital's board tries to add the role of monitoring professional behavior to it's already burgeoning list of responsibilities, the behavioral issues will be ignored in deference to ever-urgent business items. (1)

When group dynamics are characterized by a low level of trust and a high level of conflict, a medical practice may opt for an interpersonal issues committee comprised of trusted individuals from outside the practice. One example is a committee consisting of the practice manager, a selected physician, an attorney, and a human resources consultant.

Whatever its makeup, it is crucial that this committee functions independently and in parallel to other governing bodies that report to the organization's board of directors, and that it be empowered to investigate, counsel, and discipline violators.

2. Listen, empathize, and avoid communication triangles

The next step is to pay attention to how you respond to complaints. People in conflict tend to complain to a third party, rather than dealing directly with each other. Resist the pull to participate in conflict-escalating communication triangles.

* Stay calm while the complainant expresses his or her concern, and listen actively. Reflect what you hear, and show empathy for the speaker.

* Express regret that this conflict has happened, but don't use inflammatory words, and don't assume a collusive posture. Try to maintain the stance of someone who will facilitate resolution of the conflict, not that of a rescuer or persecutor of any party.

* Ask what the person would like you to do to resolve the problem. Stay focused on the specific problem at hand and state your intention to do all that you can to facilitate resolving it. Only commit to doing what is doable.