Every Practice has Conflict, But Only Some Handle it Well

Spend enough time in a doctor's office—either as an employee or a patient—and you're going to encounter conflict and tension.

For patients, already anxious about their health, even during well visits, it can be particularly unsettling to hear voices raised or accusations flying. It may be a receptionist dealing with a patient who has just been informed that his copay was raised. It could be an office manager confronting a billing clerk over a documentation error. It could be a physician assistant's personal troubles spilling into the work place.

Whatever the reason, conflict is a cancer in the healing environment. It has to be contained.

For years, Terri Levine, president of North Wales, PA—based Comprehensive Coaching U, has parachuted into stressed out physicians' offices to negotiate an end to hostilities.

"I've never seen a business, a corporation, a physician office, that doesn't have conflict," Levine says. "People are people. There is conflict in our experience. It's part of humanity." By far, she says, the most prevalent form of conflict is among coworkers.

Because of the serious nature of the work in physician offices, even on the best of workdays, stress—the seed corn for conflict—will always be present.

"There is more stress that we find particularly in medical doctor practices than in any others," Levine says. "In a retail store, you mess up, you don't ring up the right order. In a physician's office, you can be dealing with serious life-and-death issues. And the other thing is that most physicians are Type A personalities. Just by the nature of who they are, they can create stress even if they don't open their mouths."

Conflict isn't always about screaming matches at the front desk.

"Sometimes one employee could be angry with another and could be withholding information, being quiet, not giving them everything they need, forgetting to give important data and messages," Levine says. "Anger. Talking behind the other employee's back. Sarcasm. Those are the warning signs that something needs to be handled. Usually it is underneath the surface and you have to look for it because it can become a shouting match."

Paula M. Comm, a practice administrator at PRA Behavioral LLC, serving the northwestern suburbs of Chicago, says the head psychiatrist at the practice has a zero tolerance policy toward workplace conflict. "He hates conflict, and he really practices what he preaches," Comm says. "Especially in a psychiatric practice, you don't want someone coming to the window and feeling the tensions that are going on within the office because it's so apparent."

Comm says she is aggressive in sniffing out workplace tension. And one of the best ways to do it, she says, is to get out of your office and stand in the hall and listen.

"I go up there and just stand. I can get a feel for what is going on immediately. I can tell by the tone, by the attitude. I have an office manager beneath me who isn't attuned," Comm says. "So, I will go in and stand up there and go to her office and say, 'Do you know that it's tense up there?' And she will say 'what do you mean?' "

Levine says one major reason for conflict is personality differences. "We have different beliefs and different philosophies. We have different stories and programs based on our past experience," she says. "Even though I understand my job is to do X, I am still a human being bringing my own personal stuff into the workplace. I'm not going to like everybody else's personality and I may not understand exactly what I need to be doing or there might not be the same communication style between a couple of employees."

Levine says personality profiling plays a prominent role when she coaches employees at physician offices.

"Let's say I find out somebody is a director type. They give quick information; they don't like to converse. If I understand that person's style, I can use behavioral flexibility and talk to them in that way," she says. "If someone is more of a relater, they like to socialize, chit-chat. Then again, we teach how to be more behaviorally flexible in that area."

Levine says many of the employees she coaches are surprised to learn of their personality type, but their coworkers aren't.

"I was with a group last month and one person came out to be a director. The rest of the group was all saying 'Yup!' and the person said 'I didn't think I was like that.' Then as we went through specific examples of how a director behaves, she said 'Yes, that is me.' "

Levine says the way to reduce physician office conflict is not to hire the same types of people, but to make sure each employee understands one another's personality traits.

"We need a combination of personalities in the office. It's better to have all different personalities. If you've got a patient who needs TLC, get the relater our there, not the director," she says. "If you understand how your coworkers function in the world, you can have some behavioral flexibility toward them and some more understanding of who they are."

Levine says there are "three common denominators" in conflict resolution that facilitate that flexibility.

"First, be more understanding of how other people react. Second, increase group cohesion and mutual 'Let's work together to figure out the conflict.' Third, use your improved self-knowledge to understand what happens to you when you feel conflict," she says.

When employees come to her with a complaint about a coworker, Comm says she encourages them to meet face-to-face to constructively to resolve the problem.

"The worst thing is one employee complaining to me about another employee. When I confront that employee, that employee will say 'Why didn't she just tell me in the first place? Why did she have to go to you?' It's kind of like 'I'm telling Mom!' "

"The first response out of me is 'Have you spoken with her directly?' Because that is how you develop healthy relations. You talk to each other directly, because sometimes instant messaging can be misinterpreted," Comm says.