practice management

The Problem That Has No Name

Silencing conflict may jeopardize your practice. Here's how to create resolution.

BY BOB LEVOY, O.D. Roslyn, N.Y.

At a recent seminar, I asked an audience of doctors how many of them approached conflict in their offices — by simply avoiding it. A majority of hands went up. Among the reasons given: "I can't stand conflict," and "I don't like confrontation."

The fact is many optometrists ignore conflicts in their practices for years on end — simply because they can't bring themselves to deal with them. Unfortunately, the toll for ignorance is high. The environment in which people work impacts their morale, motivation, productivity and, ultimately, practice growth and profitability.

"We live in a culture, especially at work, that prefers harmony over discord, agreement over dissent, speed over deliberation," says Leslie A. Perlow, associate professor at Harvard Business School and author of "When You Say Yes but Mean No: How Silencing Conflict Wrecks Relationships and Companies … and What You Can Do About It." "The tendency to paper over differences rather than to confront them is extremely common. We believe the best thing to preserve our relationships and to ensure our work gets done as expeditiously as possible is to silence conflict." She dubs it: "The problem that has no name."

Optometric practices aren't immune to what Perlow calls "the vicious spiral of silence." Examples include staff members who stifle their feelings about overtime or an uneven distribution of the workload. Many optometrists too, may fail to confront employees who are often late for work or who are careless or perhaps socialize too much with patients.

"If no one expresses their thoughts, people will likely continue thinking and behaving in the same way, and nothing will change," Perlow writes. "Problems are likely to persist and may even get worse because corrective actions are not taken."

One of the costs of silencing conflict, Perlow says, is the effect it has on employee motivation and engagement. When work relationships are marked by pent-up frustration, the work suffers, and it's hard to be motivated.

"We don't experience a reason to put much of ourselves into our job, be creative or go above and beyond the call of duty," she says. "Instead, we may lose interest in our work and start to disengage from it and our organization — psychologically, at first, and then often physically, by quitting. This is highly costly for both individuals and organizations."

Action steps: "The best advice for anyone caught in this bind is to speak up and seek mutual understanding," Perlow says. Employee Surveys and Performance Reviews are two ways to start the process. Discussing these things may not solve all the problems. It may however, clarify them; enable you to learn each other's needs; make needed adjustments and improve morale.

If a conflict between staff members arises, many of you prefer that the staff members hash it out between themselves. If they're unsuccessful, they then take the matter to the office manager and, finally, if necessary, to you, the practice owner.

Once the issues are out in the open, you can manage conflict through three methods: (1) Win-Lose: the struggle for dominance in which one party wins. (2) Negotiation: the art of compromise, in which each party gives a little. (3) Problem-Solving: A win-win approach, in which a solution meets the needs of both parties.

Remember: Conflict resolution is likely to yield substantial benefits for your practice. OM

Four Case Studies Offer Additional Tools for Conflict Resolution

When the entire staff calls it quits

■ Dr. Smith (alias) read a lot about practice benchmarks and determined his percent of staff salary (34% of gross practice revenues) was too high. So, he announced to his staff that he would no longer give raises, but switch to a quarterly bonus if the practice grew its gross revenues by 10% or more. (The practice hadn't increased its gross in six years.)

Six months later, no growth occurred, and employees were grumbling. They united and presented a written ultimatum. "Give us cost-of-living raises, or all of us will quit."

With some communication coaching, Dr. Smith responded by asking his staff for information, such as, "what led you to believe that a small cost-of-living raise was a better option than profit sharing?" He then scheduled a meeting where his staff agreed to the following:

1. No negative attitudes.
2. No commenting until everyone shared.
3. Everyone must seek common ground. (During the commenting session, only positive or solution-focused comments were allowed.)

At this meeting, Dr. Smith also asked employees to clarify ambiguity — that is, provide specifics about dates, timelines, and amounts. Therefore, instead of staff saying, "we've tried that before," the staff clarified "before" and "that" by saying:

"In October of last year, we froze salaries hoping to increase revenue for the fourth quarter. We showed no increase in collections. If we repeat this effort, what will we do differently to achieve a different result?"

As I expected, the staff had not thought about how their individual efforts contributed to reaching the practice's goals. In addition, Dr. Smith had given them very little specific direction.

Dr. Smith ended the meeting by restating that he couldn't give raises without growth. He then reminded his employees of their value by discussing how together they had built the practice from nothing into a success. He further called attention to the camaraderie of the past and what they had overcome. Dr. Smith then assured his staff that he'd share future financial successes with them, so they'd know how close they were to receiving the aforementioned quarterly bonus, should they choose to stay.

He concluded with a sincere thank you to the staff for their hard work and a quiet statement that he would be accepting individual written resignations for the next 24 hours.

No employee resigned, and six months later practice revenue grew 20%.

— Donna A. Suter, consultant, Apison, Tenn.

Treating an offensive patient

■ In 1990, I diagnosed a patient I'll refer to as Mr. MacGregor with chronic uveitis secondary to extracapsular cataract surgery. On subsequent visits, he requested appointments with me exclusively. I traveled to Mr. MacGregor's house when he didn't have transportation to the office. During my visits with him, I discovered he was a rabid anti-Semite.

Diagnosing the prejudice wasn't difficult. During visits, he'd tell me about his "Jew bastard" tailor, and how the "Jew bastard" had a nice car and how the "Jew bastard" charged too much.

I realized I could respond to his behavior by refusing to see him, either with or without an explanation. Or, I could confront him, explaining his comments were offensive and continue to see him (hoping the confrontation would change his attitude, or at least cause him to keep his comments to himself).

I didn't choose either of these methods. Instead, I handled the conflict by listening to him, without anger. The fact was, regardless of his behavior, my job was to treat his eyes, not to become embroiled or insulted by his politics or give him advice regarding his beliefs.

Mr. MacGregor died in 1998. I preserved his eyesight and eye comfort until his last breath. I don't think he ever knew a "Jew bastard" was one of his physicians and one of his only friends.

— Andrew S. Gurwood, O.D. Philadelphia, Pa.

Choosing to resolve instead of dissolve

■ A Midwestern state optometry practice hired my consulting and management company to go "on-site" to dissolve an optometric partnership of 18 years.

Drs. C.T. Kesler and T.L. Newton had created such animosity between them, that they refused to meet with me at the same time. Of course, I honored their solo requests.

I sent a questionnaire to each employee to ascertain what effect, if any, the bad blood between Drs. Kesler and Newton had on their staff. (If a staff is unhappy, the financial health of one's practice is threatened.)

In reading the staff responses just prior to meeting with each O.D., it was evident that they deeply loved and respected both practitioners. In fact, like a "traditional" family, some employees confessed to feeling the break up was their fault. It wasn't.

The animosity between Drs. Kesler and Newton was the result of a deep lack of communication, some intimidation and the breaking of a verbal agreement between them. One major point of contention: Each O.D. had initially agreed that no family members were to work in the practice. Dr. Kesler violated this agreement by hiring his wife as a bookkeeper. This angered Dr. Newton, but he kept silent because he felt intimidated by Dr. Kesler. The bottom line: Dr. Newton enabled this circumstance by not seeking to resolve the conflict.

After taking the answers to the staff questionnaire and my individual meetings with these O.D.s into account, I felt this "professional marriage" was salvageable with a little work. So, I communicated this to each O.D. individually by telephone. After three hours, I convinced them to meet with me and their staff together.

At this meeting, I first instructed each O.D. to address the staff and apologize for their negative behavior, which the answers to the questionnaire revealed had caused a very stressful working environment. This opened a line of communication for Drs. Kesler and Newton to share their feelings, confess their flaws, (Dr. Newton's intimidation and Dr. Kesler's enabling) and prevent further and future conflict by discussing solutions. One agreed-upon solution: The practice would hire Dr. Newton's spouse.

After monitoring the situation for a few weeks, I am happy to report that these O.D.s were able to retain their partnership through recognizing their negative behavior and learning how to change it.

— Richard S. Kattouf, O.D., D.O.S., Warren, Ohio

Overly "friendly" O.D.

■ Many years ago, I supervised several entry-level optometrists in a large clinic. One day, I received a call from a patient who reported that one of these O.D.s refused to hand over copies of her spectacle and contact-lens prescriptions. She said that the O.D. told her he would give her copies only if she went on a date with him.

The first step to resolving this conflict was to meet this patient's needs by providing her with copies of her prescriptions, which I promptly accomplished.

The second and tricker step was to determine whether this O.D. deliberately disregarded moral and legal standards, or he had a simple (but huge) lapse in judgement. Unfortunately, after discussing the issue with him, his thought process on the issue was unclear to me. As a result, this aspect of the conflict remained unresolved. That is, until a few weeks later when a number of other seemingly unrelated conflicts suddenly emerged, revealing this O.D. had a flagrant disregard for moral and legal standards. The resolution: We asked the O.D. to leave the clinical program.

Thankfully, the aforementioned female patient was satisfied with the outcome and didn't pursue further action against the optometrist or our clinic.

This experience taught me the importance of handling conflict promptly and definitively, to avoid causing the irreversible deterioration of a working relationship that might otherwise have been salvaged.

Determined to prevent or at least minimize future conflicts, I examine our hiring policies, which resulted in a more stringent orientation process for new hires, particularly in state law and medical ethics. I also instituted more specific policies for grievance, discipline and dismissal. OM

— Kim Reed, O.D., F.A.A.O., Fort Lauderdale, Fla.