Conflict Resolution
Turning Around a Once Successful Practice That is Faltering

A medical group has been expanding for a decade at a steady rate and now maintains several offices in a tri-state area. As a result of exploding malpractice rates, decreasing managed care reimbursements, and shifting expectations from their community hospital, the medical group is reeling. The same problems are developing in all offices.

Issues

• Medical staff are objecting to higher work demands and lower compensation.
  
• Requests are increasing for additional vacation time and sick leave.
  
• Morale is slipping.
  
• Issues that were never important are now of monumental significance.
  
• Staff meetings, formerly amicable sessions over lunch, range from quick to non-existent.
  
• Gossip is frequent.
  
• Distrust is evident.
  
• A founding member of the group leaves.

Initial process and findings
Gail Fisher surveys group members by interviewing a cross-section of people in the medical group. From these interviews she develops talking points to interview a larger group of staff members.

She finds a general sense of distrust, dissatisfaction, and impending doom. Group members fear for their futures. However, all have a distinct memory of the initial excitement, creativity, and pioneer spirit that marked the practice's earlier days. Ms. Fisher delivers this information to management and then shares it with staff. Together, they form a planning group is formed that is charged with developing an approach that will ensure that staff members know their concerns are heard and their recommendations considered for future changes.

Next steps
The planning group considers how to help the practice retain the best from its beginnings, while taking current realities into account. Working with the planning group, Ms. Fisher holds a 1-1/2 day forum with all available staff members at which:

1. Staff members partner to interview one another about which aspects of the practice and staff they value, their aspirations for the practice and themselves, and how they believe positive staff behaviors can be enhanced.
2. The group discusses current medical realities, how staff are affected, and how staff can be "proactive" instead of internalizing dissatisfaction and making cynical and derisive comments.

Outcome
Much to the partners' surprise and satisfaction, the staff lists many positive attributes about the practice and their colleagues. The entire group takes the time to assess the practice's greatest asset - themselves as staff - and how to best utilize their skills and expertise.

Ideas generated at the forum offer a transition to a hopeful future. Energy is apparent. Staff meetings resume and are again structured to address the challenges that confront them. In place of gossip, there is renewed appreciation of one another. Subversive behaviors disappear since there is a new willingness to express dissatisfactions as they occur.