Physicians attain success through individual accomplishment in a highly competitive environment. Accordingly, while people attracted to the healthcare professions come with a wide range of attributes, they generally share one trait: a personality motivated by what David McClelland describes as a strong need for personal achievement.(1)
The Elite Professional
Elite professionals are driven by a deep desire to perform at the highest level, often accompanied by an exaggerated fear of not succeeding. Their self-worth is directly tied to ambition and competence. Many of the attitudes and behaviors elite professionals display are a byproduct of their extreme focus on high achievement.
Elite professionals are ambitious and competitive. Competition is a means by which they can gauge their level of competence. Competition doesn’t always mean with others; they can be competing with themselves to improve. Regardless, their competitive nature makes them more susceptible to conflict.
Elite professionals also are independent, valuing autonomy and the means to control the outcomes to which they aspire. Because of their need for personal achievement, they often take over tasks and projects, believing they are the only ones who can get things done right. Finally, they evaluate their work and performance according to what can be done better. This tendency makes them not only self-critical, but also critical of the work of others as well, because good is never good enough. Giving positive feedback is not their strong point.
The intense need for achievement alone does not make physicians elite professionals; rather, it’s the prestige associated with the medical profession. In his book Severed Trust, George Lundberg points out that society has historically given special status to certain professions because the members “must gain the most intimate knowledge of the person’s mind, body, and even soul.”(2) Medicine is one of those professions, and the combination of high-achieving individuals working within a prestigious profession creates the elite professional.
Herding Lions
Elite professionals are well aware of their profession’s status, and because they have unique skills, talents, and expertise that can be difficult to find, they can be strong-minded and quick to push back. Managing elite professionals is not like “herding cats;” it’s more akin to herding lions.
The economics of healthcare today drives doctors into ever-larger practice groups and closer alignment with hospital systems, requiring a more team-oriented approach that emphasizes group precision and execution.
But elite professionals, being the lions they are, content to be autonomous, will clash under these conditions because their makeup is often at odds with the values, traits, and attitudes required to function smoothly within a culture of teamwork and compliance. It is analogous to forcing untamed animals to live together in an increasingly confined environment. Conflict is inevitable.
The Coach as Facilitator
When lions fight, the intensity of the dispute can be considerable and sometimes bears little relation to the size or importance of what triggered the conflict. Similarly, elite professionals’ sense of status, reputation, and need to be “right” are embedded into almost every issue, even small ones. Therefore, a certain amount of competition and friction is inevitable and can be productive when well-managed. Still, excessive or inappropriate conflict will cause an organization to unravel as teamwork deteriorates and patient care suffers. Enter the coach leader.
When intervening effectively, a third party can help those in conflict resolve their differences. Helping people work through conflict situations is critical for those who wish to embrace coaching as a leadership style. But the question often asked is, “What exactly am I supposed to do?”
The answer, of course, depends on the specifics of the situation. However, the first thing to realize is that the coach’s very presence in a dispute can change the dynamics of the interaction between the combatants and sometimes reduce the conflict and positively affect the outcome of a dispute, regardless of the problem.
Your Presence
People generally behave more civilly in front of others, particularly their leaders. Likewise, two disputants probably will conduct their discussion in a less emotional and hostile manner in your presence than they would if left to themselves.
One of the least intrusive ways to involve yourself as a coach is to sit down with the persons involved and encourage them to talk through their issues in front of you. If things get out of hand, you can always inject some settling words to calm them down. Your role is to act as an unbiased third party and infuse rationality into the discussion to enhance their ability to solve the dispute. Practically speaking, your ability to do this is inversely proportional to how much “skin” you have in the game. The more vested you are in the outcome or the issue, the more difficult it will be to play the role of objective facilitator.
Before meeting with them together, it may be beneficial to meet with them individually. Doing so will help you better understand where each person is coming from because they are more likely to discuss their interests and concerns calmly when the other party is not around. Additionally, by hearing each person’s side of the argument, you often can gain insight into how best to intervene and even develop some ideas for resolving the conflict.
Your Facilitative Role
Facilitating a resolution involves your active participation in the conversation but not in the substance of the conversation. Your role is to focus on process, not content. To do so, ask yourself the following questions as you listen to the discussion:
Are they treating each other respectfully and not engaging in personal attacks directly or by innuendo?
Are they following the rules for good communication, e.g., not interrupting, asking questions for clarification instead of making statements or judgments, etc.?
Are they operating from a mutually understood set of objective facts and information rather than opinions or assumptions?
Are they staying on topic rather than drifting into areas unrelated to the issue?
Are they focusing on the future versus reliving the past?
If the answer to any of the above questions is “no,” a process violation has occurred. When a process violation occurs, you must point it out so the participants do not get in their own way as they work through their differences. You can do this directly or indirectly. For example, suppose topics irrelevant to the issue are inserted into the discussion, or minor points get elevated into major ones. You might point out that what they are discussing is unrelated to the problem at hand. Or, you can take an indirect approach by asking them questions such as, “How is this topic relevant to the issue you are discussing?” Either way, you are bringing to light a process violation that impedes an effective discussion.
One interesting strategy is the “dumb fox” technique: acting as if you are confused even when you are not so you can ask a question or make a statement that addresses a process violation. What if you believe one person does not understand what the other person is saying? By acting confused and asking them to restate what they are saying so that you have a better grasp of their point, you slow down the conversation and create the opportunity for the person to hear it again. For example, “Maybe it’s just me, but would you say that again so I can ensure I understand you?”
You also can use your “confusion” to paraphrase what you heard so that everyone hears the essential idea or point of discussion. For example, “I’m a little slow today, so let me see if I hear you correctly. What I hear you saying is that (insert the paraphrase). Is that correct?”
The dumb fox technique can be used with any process violation. For instance, in the example referred to in a previous paragraph, you might say, “I’m confused, and I don’t see how the topic you are discussing is relevant to the issue at hand.” Regardless of how you do it, intervene when process violations hinder conflict resolution.
Besides listening for and addressing process violations, you can help elite professionals work through issues by identifying commonalities and points of agreement. People in conflict are generally focusing on differences. But those differences may be minor when set against areas of agreement. You inject a positive dynamic into the conversation by directing their attention to areas of accord.
To this end, be aware that people often say the same things but use different words, making it sound like they disagree. The term for this is violent agreement. If you suspect this is happening, merely ask one party how what they are saying is different from what the other person is saying, or directly point out that they are saying the same thing using different words. However you do it, find points of agreement and make them explicit whenever possible.
There Is Hope
Coaching lions is not easy, but the good news is that you are typically dealing with intelligent, motivated, and well-intentioned people. If you’re going to be a successful coach-leader, learn to help elite professionals overcome their natural tendencies and coach them through the conflicts that will assuredly arise from their high-stress environment and day-to-day interactions.
References
McClelland DC. The Achievement Motive. New York, NY: Irvington Press; 1976.
Lundberg GD, Stacey J. Severed Trust. New York, NY: Basic Books; 2022.