Keeping the peace: Can't we all just get along?

It's never easy to know what's going to make a staff member upset. It could be that the billing person didn't say hello. Or maybe paperwork was left out from the night before. Or maybe there's a personal issue, like the kids being sick at home.

It's not likely that everyone in the office is going to sport a smile all day. And when people are grumpy, the possibility for conflict arises.

Managing conflict is an activity most busy physicians would rather avoid, but unchecked battles between staff members can lead to decreased efficiency and mistakes in the office, which can contribute to lost or missed revenue.

As tempting as it is to take a hockey referee's approach -- let the two combatants slug it out and step in only when one appears to be winning -- it's more prudent to make a proactive effort in keeping conflict out of the office, experts say. If a conflict does occur, a little organizational behavior knowledge can diffuse the crisis.

There are plenty of ways to keep the peace in your office, but the best strategies to deal with conflict involve open communication, clear job descriptions and a culture of teamwork, consultants said.

"Most conflict happens because people see things differently," said Jill Miller, a business development consultant in Wichita, Kan. "The biggest thing is putting energy into it instead of just ignoring it."

Understanding your employees' personality traits, how they act and think, and what motivates them, can help you blend their talents into a cohesive office structure. It doesn't always work to just tell an employee to stop complaining and do the assigned job, or to order two employees to solve their own differences.

One of the best approaches is to prevent conflict, but you can't do that unless you understand where your employees are coming from, consultants said.

"A lot of organizations don't spend time trying to avoid conflict. They treat it like a venereal disease: If they don't have it, they don't deal with it," said Lyman K. "Manny" Steil, PhD, president and CEO of Communication Development, a St. Paul, Minn.-based consulting firm specializing in communication training and professional development. "You avoid conflict by putting it on the radar screen."

In other words, if you can anticipate problems, you don't have to deal with them after they've become a full-blown office controversy.

Open the lines of communication

Thomas Weida, MD, has learned to anticipate that, in his office anyway, February will be the longest month of the year. February means sickness, which means more patients, and less patience. Stress among the staff is high and tempers are quicker than usual, which inevitably leads to conflict.

But seeing the conditions for a perfect storm doesn't mean you have to live through it, said Dr. Weida, a family physician in Hershey, Pa., and a professor at the Penn State College of Medicine.

"It's a matter of trying to catch it as early as possible," said Dr. Weida, who also serves as speaker of the American Academy of Family Physicians. "You have to keep an ear to the pavement, keep a sense of what's going on in the office. For some, it's not even formal. It's just a simple, 'How's it going?' "

Even friendly chitchat with staff members can open the lines of communication immensely, consultants said. A physician who interacts with staff creates a culture in which staff members can be friendly with each other and address issues without bottling them up and letting them fester.

J. Michael Patton, MD, a family physician in Wichita, Kan., said his office holds quarterly team-building sessions with a focus on particular issues, giving employees a chance to clear up misunderstandings and develop a unified interest on certain topics.

The practice also has identified things employees can do to be part of the team, and it has molded those concepts into measurable actions that are monitored throughout the year, he said.

"When we have our annual reviews with each person, that's an important part," Dr. Patton said. "It's not just the task they do or how they do it, but they have to do it in a proper manner. Like it or not, a medical office is a service entity."

Developing teamwork in the office also was dependent on creating specific job descriptions for each employee. The office did not have anything detailed in writing, and when the physicians and office manager noticed employees having trouble deciding who should take on what responsibilities, they realized some definitions were needed.

Staff members helped create their own descriptions, said Miller, who assisted the office in handling conflict issues.

"I found if people have a hand in creating it, they have a lot more ownership in it," Miller said. "It gave us an opportunity to recognize people when they did a good job. And the best thing was, it let people know when their behavior was unacceptable."

Clark Taylor, MD, a facial cosmetic and reconstructive surgeon in Missoula, Mont., also has very detailed job descriptions as part of the extensive policy handbook employees receive when they are hired at his surgery center, Cosmetic Surgical Arts Center.

All new hires also undergo extensive training to teach them to shift their thinking from one of reaction to one of critical thinking and observing.

Dr. Taylor calls it his own style of Special Forces training. While it results in a high turnover rate, with employees leaving early in the process, the employees who see it through "emerge from the jungle into a much higher level of function," he said.

Employees are told they need to follow policies explicitly, because in medicine, mistakes can cause serious damage to a patient, Dr. Taylor said. Detailed written rules leave little room for interpretation, reducing the possibility for conflict.

"Every action they take must go back to a written policy, and verbal communication is only meant as a guide," Dr. Taylor said. "At the end of the day, it boils down to a policy issue or a personnel issue. The whole process is training people to think with their heads and not their hearts."

Addressing the problems that occur

An office can't avoid every conflict, however, so resolution has to be a strategy in a doctor's repertoire.

Philosophical changes can go hand in hand with physical alterations, so sometimes you can prevent conflict by just tweaking your office arrangement.

Employees at Dr. Patton's practice seemed to congregate in the file room to gossip. When more lighting was added to the room, there was a marked decline in gatherings. And when two employees were having trouble getting along, the supervisors separated their desks.

"We moved them six feet away from each other, and the conflict went away," Dr. Patton said. "It was a simple fix."

Those types of strategies won't always work, especially if the conflicts have deep roots. Instead, physicians might need to step in and play mediator between two employees. That can become dangerous territory, consultants said.

"Most doctors will step in and say, 'Get your act together,' or try to get both sides to reach a consensus," Dr. Steil said. "No matter what happens, when you try to play mediator, that's an area doctors are not skilled at."

When time and money are short, however, you might have no one else to turn to when it comes to addressing the issues. Consultants suggest speaking to both sides, listening carefully, and trying to get each person in the conflict to see it from the other person's perspective.

Helping employees find ways in which they are in agreement can help smooth the ice initially, and asking each person to solve the problem from the other's point of view often leads to compromise, Dr. Steil said.

Compromise usually offers a better resolution than a physician or office manager hearing both sides and making a ruling, which can give the impression that some employees are more valued or favored, experts said.

Strangely enough, an employee can feel left out in nearly any situation, from disciplinary meetings to praise. If the system is set up correctly and a physician is in touch with staff members' feelings, overcoming those issues should not be difficult.

"Rather than setting a high threshold, it should be lower," Dr. Weida said. "You should have a formal program and make it a fair process, so everyone knows they have an equally good opportunity to earn recognition."

After all, an employee who perceives management isn't fair is likely to be involved in conflict, forcing a doctor to take time away from patients to deal with the issue.

"It's better to [address problems] informally unless it's a repeated thing," Dr. Weida said. "You're trying to keep an upbeat attitude in the office and an idea of teamwork, of helping each other out."