Conflict Resolution and Management for Medical Practice Teams: Twenty-Five Tips

Staff conflict occurs in the medical practice for many different reasons. These range from high-minded philosophical differences and divergent goals to some of the more unsavory aspects of staff management, including power imbalances, ego struggles, selfishness, false assumptions, opposing personalities, jealousy, and laziness. Unfortunately, unresolved and poorly managed conflicts can quickly lead to a breakdown in team trust. And because a medical practice’s success typically hinges on the cohesion of a team of relatively few people, staff conflicts can quickly and aggressively eat away at productivity, destroy goodwill, and make everyone’s job harder.

Petty conflicts may lead coworkers to harbor grudges or passive-aggressively avoid one another.

Unnecessary employee turnover is one of the most costly negative consequences of conflicts. Most medical practice employees are not hard-wired to deal with conflict casually. Therefore, conflict tends to take up their time and energy both during and outside of work. Petty conflicts may lead coworkers to harbor grudges or passive-aggressively avoid one another. Valued employees often are tempted to jump ship from medical practices where conflict has run rampant, and find calmer and more peaceful practices in which to work.

Fortunately, medical practice managers can gain a basic understanding of effective conflict avoidance, conflict resolution, and conflict management strategies. They can prevent employee conflicts, nip conflicts in the bud, and deal effectively with those that persist before they spin out of control.

Is All Conflict Bad?

Most medical practice managers want to avoid or reduce staff conflict, and for good reason. It is generally a good practice to avoid conflict when you can. (See Ten Conflict Prevention Strategies later in this article.) But not all conflict in the medical practice is necessarily bad.

According to Richards,(1) conflict “encourages open-mindedness and helps avoid the tendency toward group think that organizations fall prey to.” As Richards explains, effectively managed conflict can serve as a catalyst rather than a hindrance to organizational improvement. It can encourage new thinking, raise questions, build relationships, open minds, and beat stagnation.

Therefore, if you can’t prevent a conflict among members of your team, don’t jump to the conclusion that the conflict is necessarily bad. First, consider any positives that may be wrapped in the conflict. Ask: What can I learn from this conflict that will help me improve my team, my practice, or my own management? How can this conflict make things better? Then take steps to manage or resolve the conflict.

Conflict Management Versus Conflict Resolution

Conflict management involves the control, but not resolution, of a long-term or deep-rooted conflict. This is the approach taken when complete resolution seems to be impossible, but something must be done. According to Spangler,(2) conflict management is what you can do so that the conflict becomes more constructive and less destructive. The goal of conflict management is to intervene in ways that make the ongoing conflict more beneficial and less damaging to all sides. Adds Spangler, “In many cases, where deep-rooted, fundamental values and/or non-negotiable human needs are at stake, management is the most feasible step.”

Conflict resolution, on the other hand, is a way for two or more parties to find a peaceful, fair, and lasting solution to a disagreement between them. To end or resolve a conflict, especially one that is long standing, a relatively stable solution is needed that identifies and deals with the underlying sources of the conflict. That way, the conflict will not occur again.

Conflict resolution is desirable in most cases, but it is not always possible.

Of course, conflict resolution is desirable in most cases, but it is not always possible. Therefore, when faced with a conflict in your medical practice, assess the situation first to see if a peaceful and fair resolution is feasible. If it is not, then create a strategy to manage the conflict. For example, suppose you have two employees who just do not get along. First, see if it will be possible to resolve the conflict. Consider strategies and resources that will help them repair and improve their relationship. Then, if you find that conflict resolution won’t be possible, and you wish to keep both employees, decide how you will manage the conflict. For instance, you may choose to establish new rules for them about their behavior. Or you may reassign their job duties or shift their schedules to minimize their contact with one another. Or if your medical practice has two or more offices, you may transfer one of the employees to another of your offices. These conflict management strategies will keep the problem from escalating and spilling over into the rest of your medical practice.

Ten Conflict Prevention Strategies

Most people agree that although conflict can be beneficial in some instances, it is usually best avoided. Fortunately, there are many things you can do to prevent conflicts between the members of your medical practice team. Here are 10 of the best conflict prevention strategies:

1. Anticipate and head off conflict. Don’t create or allow a fertile breeding ground for conflict. When the situation seems ripe for conflict, change it, or help your team to anticipate, head off, and quash conflicts. Two excellent ways to do this are to get to know the different personalities in your team and to take note of times when conflict has been more likely. Then, you can take preemptive action when you anticipate a strong potential for conflict. For example, suppose that two of your employees have locked horns in the past but that you need them to work together on a new project. You might decide to meet with them before assigning the new work to them, so you can facilitate a discussion about how they can work more effectively together. Alternatively, you might help them establish new ground rules for avoiding conflict as they move forward. Or suppose you know that conflicts are more likely to occur in your practice during times when staff members are out on vacation and your practice is understaffed. You might decide to engage the services of a temp agency to fill short-term gaps in your staffing, reducing the likelihood of conflict. Or suppose you have a multigenerational team and that you have observed past conflicts between younger and older employees. You might hold a multigenerational workplace workshop for your staff so your employees can learn more about their generationally based experiences.

2. Establish clear expectations. Conflict often results from a lack of clear expectations. Make sure that everyone in your team is aligned with your medical practice’s vision and mission and that each team member knows specifically what he or she is trying to achieve. Be explicit about deadlines and about the outcomes you expect from individuals and the team. Do cross-checks to ensure that your employees know what you expect of them. Create clearly defined job descriptions to head off finger pointing, “it’s not my job,” and other conflict triggers.

3. Invest significant time on new projects and new hires. Vrabie(3) suggests that this strategy goes hand in hand with establishing clear expectations. Spend time with new projects and new hires to start things off well. In so doing, you may be able to avoid misunderstandings, conflict, and the need to spend a lot more time fixing things later, Vrabie says.

4. Model and teach respect. According to Morera,(4) people’s behavior in a workgroup is the best predictor of conflict. Make yours a medical practice in which everyone at all levels consistently treats others with respect. Explain the importance of using a respectful tone, choosing the right words, civility, and actively listening to what the other person has to say.

5. Establish conflict guidelines. Although it’s ideal for employees to feel empowered to address conflict on their own, they need to be able to bring unresolved issues to their managers. Establish guidelines for resolving conflict in your medical practice. Include steps to follow when reporting the conflict, the actions to take, and how to prevent the conflict from recurring.

6. Define acceptable behavior. Clearly and publicly make it known what behaviors will and won’t be tolerated in your medical practice. Ask your staff to help you define your team culture, what you believe and do as a team, and how you treat one another.

7. Establish boundaries. According to Shichel,(5) good fences make for good work relationships. Encourage employees to be sympathetic to one another, but also, not to become embroiled in each other’s personal issues. Don’t tolerate meddling, nosiness, rumors, or gossip, and don’t allow employees to bring their personal problems that interfere with the work into your medical practice. Step in if they’re oversharing.

8. Address performance problems. Conflicts are likely to occur when employees have to work with a slacker. While you can’t disclose specific measures you are taking to address low performance, let your employees see that you are generally holding them accountable for their performance. If asked specifically about a below-par employee, Jagoda(6) suggests, “Make a generic comment when asked to the effect that you are handling the problem, or, if possible, restructure work responsibilities to move the poor performer into a different role.”

9. Allocate scarce resources carefully. Who gets what is a common source of workplace conflict, especially when there isn’t a lot of “what” to go around. Jagoda(6) suggests that managers must be creative in how they allocate scarce resources. For example, you might hold a raffle for the few new computers to see who gets them first, Jagoda suggests. Or you might reward high-performing employees when promotions are unavailable. Whatever you do, don’t allow scarce resources to become a “bone of contention” among your employees, Jagoda warns.

10. Identify and respond to small problems before they escalate into full-blown conflicts. Don’t wait for small problems to clear up on their own. And don’t put problems on the back burner until you have more time to deal with them. Left unchecked, small problems often get bigger. Listen to your inner voice. According to the HR Council,(7) “An early sign of conflict is that ‘nagging feeling’ or tension you feel, indicating that something is brewing under the surface.” If something doesn’t feel right to you, it probably isn’t.

Twenty-Five Tips for Managing and Resolving Conflicts

No matter what you do to prevent conflicts in your medical practice team, some conflicts will be inevitable. Here are 25 tips to help you when you must be involved in managing or resolving employee conflicts:

1. Accept conflict that you can’t prevent. Remember that conflict is natural and that it happens in every ongoing relationship, including those in the medical practice. Regard conflict that you can’t avoid as a sign of a need for change and an opportunity for growth, new understanding, and improved communication.

2. Acknowledge that a difficult situation exists. Honesty and clear communication play an important role in conflict resolution and management. Be open about what you’re seeing with the employees involved, and the overall impact of the problem on your medical practice. If the conflict is affecting other members of the team or your patients, describe specifically when and how much.

3. Let the employees in conflict own the problem. Remind them of their greater purpose as members of your medical practice team and, if need be, that they are adults. Tell them that you will help them by facilitating discussion, but that it is up to them to manage or resolve the conflict.

4. Let people tell their story. When your employees are deeply upset about something, they will need to get their story out—all of it. This is a basic principle of mediation and one that’s important to remember in conflict management and resolution. Don’t rush them or have them fast-forward to the end of the story. Let them get it all out.

5. Hold private meetings if necessary. Meeting privately will give each employee involved in the conflict an opportunity to share sensitive information, practice how he or she might ask for what he or she needs, apologize for his or her role in the conflict, or acknowledge the positive aspects of the working relationship.

6. Identify the real source of conflict. In many instances, the conflict at hand isn’t the true conflict. There’s usually something beneath the surface, perhaps competing interests that are being challenged. For example, if a team member gets into a conflict with another employee about emptying the dishwasher in your break room, the anger may stem from a feeling that he or she isn’t appreciated or shoulders too much of the workload in general. Picking a fight over the dishwasher is how the feeling manifests itself. Listen carefully and ask thoughtful questions to uncover the hidden feelings beneath the surface conflict.

7. Get employees in conflict to highlight and categorize their obstacles. With your help, they may discover that some of their obstacles can’t be controlled, such as personal beliefs, lifestyle choices, and personality traits. Help your employees to view such obstacles between them more objectively. Then, guide their focus to the obstacles between them that they can control.

8. Teach your staff not to react in the heat of the moment. According to Marter,(8) this is not easy to do because we are biologically primed to fight or flee. However, not reacting in the moment can be incredibly effective. Says Marter, “It takes two to play tug-of-war, and if you refuse to engage, there is no game to be played.” An intentional pause serves as a mirror for the antagonizer, as his or her aggressive words reverberate in the silence and seem to hang in the air, hopefully inspiring reflection and awareness, Marter says. If you teach your staff to refuse to react in the moment, you can help them to be the bigger person and to anchor the conflict in a more civil place before it spirals downward. Of course, this requires strength, patience, groundedness, and detachment from ego, Marter says. Teach your staff embroiled in a conflict to pause, count to 10, breathe deeply, and see what happens from there.

9. Be a calming agent. Your response to the conflict can escalate or decrease the intensity of the problem. To be calming, provide an objective or neutral point of view. Keep your tone and body language easy and calm. Then, help your employees calmly plan how they are going to work with one another to resolve or manage the conflict.

10. Analyze the conflict. Ask questions to help you and your conflicted employees to clarify the specific problem. For example:

    • What triggered the conflict?

    • Who are you angry with?

    • What are you not getting that you want?

    • What are you afraid of losing?

    • Is your conflict/anger accurate or over exaggerated?

    • How can your conflict be resolved?

11. Model neutral language. When people are in conflict, they often use inflammatory language such as profanity, name calling, and exaggerations that escalate the conflict. Restate inflammatory language in a more objective way to help make the charge less emotionally laden and more useful for future discussions. For example, if one of your employees says that the other is “lazy,” you might reframe it: “Please tell me if I am understanding you fully. You are saying that [name of coworker] is not putting enough time and effort into her work and that it is affecting you. Do I understand you correctly?”

12. Teach your employees to separate the person from the problem. Help them to view the problem as a specific behavior or set of circumstances, rather than attributing negative feelings to the whole person. This approach makes the problem more manageable.

13. Avoid taking sides. You may, in truth, align with one party more than the other. However, trying to get in the middle by promoting one’s case to the other is dangerous. This may, in fact, be interpreted as favoritism by other employees and have an adverse effect on your reputation and credibility. Remain objective and impartial, even if you support one party’s position and not the other’s. Keep your focus on what’s best for your medical practice, not for one employee over the other.

14. Focus on the future. In conflict, we tend to remember every single thing that ever bothered us about that person. Staff members in conflict may need or want to vent about the past, but too much of that may not be productive. Often, the best way to take ownership of the problem is to recognize that regardless of the past, you need to create a plan to address the present conflict and those that may arise in the future. Help your team members in conflict to heal old wounds once and for all, and to focus on moving forward. Ask: “What would you like to see happen now?”

15. Maintain confidentiality. Encourage others who are in conflict to deal directly with the person they are in conflict with and with you. Venting to other members of the medical practice team tends to escalate the conflict and fuel the rumor mill. If rumors are already part of the problem, encourage team members in conflict to work out a plan to put an end to the gossip. Do your part to quell rumors.

16. Teach your staff to use “when . . . I feel . . . because . . . I would like” statements. Framing the conflict from the first person is less inflammatory than accusatory “you” statements. For example, instead of saying, “You are so rude to me when you ignore me,” the employee might say: “When you walk by me or sit in the same room with me and don’t acknowledge me . . . I feel uncomfortable and hurt . . . because I start to feel that you would prefer it if I’m not here. I would like it a lot if we can acknowledge one another cordially when we see one another.”

17. Encourage face-to-face communication. Help your employees in conflict to share their negative emotions with one another only in person. E-mails, voicemails, texts, and notes are too impersonal for the delicate nature of negative words. A negative sentiment on paper may come across like a grenade. Moreover, anything said in print can be shared with or circulated to other members of your team. This can be very damaging.

18. Defuse anger by reiterating or repeating what your conflicting employees say. This mirroring technique, called reflective listening, can keep both you and your conflicting employees centered in a difficult conversation. Often, it will help employees who are upset to calm down, simply because they know that you have heard them. The technique can also get employees who are reluctant to say much to open up to you. For example, if an employee says, “I must have looked like an idiot to the patient” because of something a coworker did or did not do, you might mirror, “You felt like an idiot.” That will encourage the employee to say yes and keep going.

19. Stop verbally abusive or other inappropriate interactions immediately. Firmly but calmly state, “You’re both very angry right now. I’m going to excuse myself. We can talk again after you both calm down. Till then, do not discuss this matter with one another or with anyone else.” Then leave the room or ask the conflicted employees to return to work. If you feel that one or more of them is so angry that that will not be possible, send them home. It will be better to be understaffed than to have a powder keg explode in your medical practice.

20. Bring a reality check to the table. Often in a conflict, the parties are so focused on minutiae that they lose sight of the big picture and its implications. As the practice manager, you will need to bring your employees in conflict back to reality. Doing so may help them resolve the conflict much sooner. For example, if one of your employees is overly upset because another honestly forgot to do something, you may have to remind him or her that we all make mistakes and that the error wasn’t catastrophic.

21. Find common areas of agreement, no matter how small. For example, help your employees in conflict to agree on the problem, the procedure to follow, worst fears, and small changes that will help to move things forward.

22. Find solutions to satisfy needs. Help conflicted employees to brainstorm multiple alternatives. Facilitate a discussion of which actions will be taken. Make sure all of the parties involved buy into actions. (Total silence may be a sign of passive resistance.) Be sure you get genuine agreement from everyone.

23. Determine follow-up you will take to monitor actions. For example, schedule a follow-up meeting to determine how the parties are doing. Be sure the conflict is managed or resolved.

24. Determine what you’ll do if the conflict goes unmanaged and unresolved. For example, if the conflict continues and is causing a disruption in your medical practice, you will have to explore other avenues. An outside mediator may be able to offer other insights on solving the problem, but that can be costly. In some cases, the conflict may become a performance issue. If so, it may become a topic for coaching sessions, performance appraisals, or documented disciplinary action.

25. Look for bigger conflict patterns in your medical practice. Frequent or recurring staff conflicts may indicate a problem with your team composition. Sometimes, people are simply incompatible, and should not be working together. Although no team is perfect, your employees should not be constantly at each other’s throats. If they are, focus more on your hiring practices. Spend more time considering not only the skills and strengths of job applicants, but how they will mesh with the other members of your team.

References

1. Richards L. How can conflict be good for an organization? Chron. http://smallbusiness.chron.com/can-conflict-good-organization-741.html . Accessed March 21, 2016.

2. Spangler B. Settlement, resolution, management, and transformation: an explanation of terms. Beyond Intractability. May 2013. www.beyondintractability.org/essay/meaning-resolution . Accessed March 21, 2016.

3. Vrabie A. 10 Things you can do to avoid conflict in your team. Sandglaz. September 13, 2013. http://blog.sandglaz.com/10-things-you-can-do-to-avoid-conflict-in-your-team/ . Accessed March 22, 2016.

4. Morera N. Tips to prevent conflict in the workplace. Talent Management. May 12, 2011. www.talentmgt.com/articles/tips-to-prevent-conflict-in-the-workplace . Accessed March 22, 2016.

5. Sichel M. Workplace etiquette: how to avoid conflict in the workplace. The Sideroad. www.sideroad.com/Business_Etiquette/workplace-etiquette.html . Accessed March 22, 2016.

6. Jagoda. Five actions managers can take to reduce workplace conflict. Conflict Tango. August 21, 2013. www.conflicttango.com/five-actions-managers-can-take-to-reduce-workplace-conflict/. Accessed March 22, 2016.

7. HR Council. Workplaces that work: conflicts at work. hrcouncil.ca . http://hrcouncil.ca/hr-toolkit/workplaces-conflict.cfm . Accessed March 22, 2016.

8. Marter J. 10 more tips for effective conflict resolution. Huffpost Healthy Living. January 14, 2014; www.huffingtonpost.com/joyce-marter-/conflict-resolution_b_4565052.html . Accessed March 23, 2016.

Common Sources of Conflict

Medical practice managers will be best equipped to address conflicts if they know what has caused them. The HR Council(1) identifies six common sources of workplace conflict:

Reference

1. HR Council. Workplaces that work: conflicts at work. hrcouncil.ca . http://hrcouncil.ca/hr-toolkit/workplaces-conflict.cfm. Accessed March 22, 2016.

Six Outcomes of Employee Conflict

Dislike and hatred among employees can stem from any number of work- or non–work-related conflicts. Perhaps your employees are from different social circles or have differing backgrounds. The problem could be the way they do or don’t do their work. Perhaps the ill will stems from something trivial, such as the sound of a coworker’s voice or the malodorous lunch he or she eats in the other’s vicinity. Or perhaps you have two employees who were once best friends but have had a falling out over something that has nothing whatsoever to do with work and that is outside your control.

Gorey(1) suggests that, no matter what has happened to cause the conflict, there are six possible outcomes for resolving a conflict between employees who hate each other:

1. Both parties work out their differences, rise above them, and move on.

2. Both parties agree to disagree, but get past it and move on.

3. Both parties say they’ve moved on, but one or both secretly harbor continued ill will. Negativity lurks and performance soon begins to dip.

4. One party sucks it up and acquiesces while the other seemingly wins. Conflict may continue.

5. The “wrong” party won’t budge and needs to be removed from the department and possibly let go.

6. The situation damages both employees, and both leave.

Warns Gorey, “You’ve probably encountered people in your personal or professional lives who always seem to be mired in drama and have a knack for dragging others into their issues. If you think, ‘Here we go again’ regarding one of the employees involved in the conflict, then that’s probably a sign that the person needs to change their [sic] attitude or be terminated.”

Reference

1. Gorey A. When employees hate each other: 6 tips for resolving coworker conflict. Workplace 101. August 25, 2014. http://info.profilesinternational.com/profiles-employee-assessment-blog/bid/81154/When-Employees-Hate-Each-Other-6-Tips-for-Resolving-Coworker-Conflict. Accessed March 22, 2016
   

Are You Conflict Averse or Resistant?

Although medical practice managers will want to anticipate and head off team conflict when they can, they must also be willing to manage and resolve unavoidable conflict. But what if the practice manager finds conflict so uncomfortable that he or she runs from it, and won’t deal with it effectively?

Fusion(1) suggests that managers should assess their own attitudes to see whether they are programmed to avoid or resist conflict. If they are, she suggests that they reprogram their thinking. Positive affirmations can help, such as these:

• A mutually acceptable solution is possible.

• A mutually acceptable solution is desirable.

• Cooperation is better than competition.

• Everyone is of equal value.

• Other people have legitimate viewpoints.

• Differences of opinion can be helpful.

• Team members are trustworthy.

• The parties will choose to cooperate.

Reference

1. Fusion J. How to avoid conflict with people. Chron. http://smallbusiness.chron.com/avoid-conflict-people-742.html . Accessed March 22, 2016.

The Real Cost of Medical Practice Team Conflict

When CPP Inc.(1) (publishers of the Myers-Briggs Assessment) commissioned a study on workplace conflict, it found that in 2008, U.S. employees spent 2.8 hours per week dealing with conflict. This amounts to approximately $359 billion in paid hours (based on average hourly earnings of $17.95), or the equivalent of 385 million working days. That’s a lot of time spent gossiping, protecting turf, retaliating, recruiting people to one side or the other, planning defenses, and navigating the drama. More importantly, that’s time not spent doing the job employees were hired to do.

As Lawler(2) suggests, findings from the CPP study should be enough to spur any “wait and see” medical practice managers into action. For example, 25% of employees said that avoiding conflict led to sickness or absence from work. Equally alarming, nearly 10% reported that workplace conflict led to project failure, and more than one-third said that conflict resulted in someone leaving the organization, either through firing or quitting. “Those negatives translate into real financial losses for employers,” Lawler says.

For example, if an employee uses five sick days a year to avoid conflict, that’s a direct cost of over $700 to your medical practice (calculated using the above hourly earnings), not to mention the cost of covering the employee’s missed work (e.g., overtime pay for another employee or hiring a temporary employee). As well, employee turnover owing to conflict can be hugely expensive, Lawler says. Consider the costs of filling a vacant position: recruitment costs, training the new hire, paying other employees involved in the hiring and training process, paying severance, and the lost investment you made in the previous employee (including his or her knowledge). Replacing an employee will cost you 150% to 200% more than that employee’s salary and benefits. This means that losing an employee making $30,000 a year could cost your medical practice $70,000 or more to replace, Lawler says.

References

1. CPP, Inc. Workplace Conflict and How Businesses Can Harness It to Thrive. CPP Global Human Capital Report. July 2008; http://img.en25.com/Web/CPP/Conflict_report.pdf . Accessed March 22, 2016.

2. Lawler J. The real cost of workplace conflict. Entrepreneur. June 21, 2010. www.entrepreneur.com/article/207196 . Accessed March 22, 2016.