Stuck in the middle

IN AN ideal world everyone would work well together, respect their colleagues and get the job done as one big happy team.

But for many managers, the reality of day-to-day practice can be a challenging mix of differing personalities and working styles that sometimes leads to conflict. And while some level of conflict is normal in any workplace, it is vital that problem areas are addressed in the right way to prevent issues escalating to the point where the running of your practice, and its staff, suffer.

Disagreements can be caused by any number of issues, both major and minor. Often problems can build up over time before eventually boiling over into a full-blown dispute. As practice manager you may find yourself stuck in the middle when working relationships begin to break down, fielding complaints and comments from all sides.

A crucial skill for any manager in successfully resolving conflict is learning how to mediate. This means being able to identify problems early and tackle them swiftly and effectively. Mediation is a flexible, confidential process that involves an impartial third party – which may be you, the practice manager – helping people who are in dispute to reach an agreement.

Practice disputes can centre on various issues, from financial disagreements over budgets or locum costs to workplace problems like bullying and harassment. Partners, for example, may disagree over how much money should be invested in the practice in terms of employee salaries, patient services or even in how much should be spent on the upkeep of the premises.

The BMA strongly recommends that GPs draw up a written partnership agreement and seek legal and accountancy advice in doing so. This can help avoid many practice disputes which focus on financial or other partnership issues. The BMA guidance document Medical partnerships under the NHS offers more advice on this.

A breakdown in communication will often be at the heart of a workplace conflict. GPs or GDPs may feel they are not being listened to by their partners or that their decisions are being ignored or undermined. The balance of power within a practice is another common source of conflict. The senior partner who insists "what I say goes" can cause simmering resentment among partners and staff, as can a lack of clear responsibilities. For example, the staff member who protests "I do all the work around here and he does nothing" could have a valid complaint that, if ignored, may eventually escalate into a full-blown dispute.

SWIFT ACTION

Whatever causes conflict in the practice, it is important that practice managers recognise the warning signs early.

Hugh Donald is a trained mediator with the firm Core Solutions and has more than 25 years’ experience in the medico-legal field. He says: "These can be small things like noticing that certain GPs, GDPs or staff members are not contributing during practice meetings or are avoiding the meetings altogether. You might notice certain individuals are avoiding each other in the break room or hear of complaints about the way the practice is run. Whatever you do, don’t ignore it."

The longer a problem is ignored, says Hugh, the more likely it is that entrenched positions will form on either side of a conflict, which may make finding a solution more difficult. He says: "The best approach tends to be a collaborative one which encourages people to work together to identify the cause of the conflict and find ways of addressing it. Collaboration is what takes you into the mediation process."

FIRST STEPS

Once you notice there is conflict in the workplace that needs to be addressed, it’s important to begin the mediation process early and with an open and objective mindset. Mediators should first make contact with the parties involved individually to find out their concerns and needs.

Liz Price is the training and consultancy manager at MDDUS and has considerable experience in helping practices manage workplace conflicts. She says: "Ask each party what they would like to happen in order for the problem to be resolved. Really listen to what is being said and remember not to take sides. You may need to go back and forth between the parties a few times, noting what they say and listing possible solutions."

Using open questions such as "So what’s been happening?" or "Can you tell me more about…?" can help identify the main issues before you go on to explore possible solutions. You should ask people what they need from the other parties rather than what they think of them. This might present an early solution as you may be able to change the way the practice works, for example, or simply help someone understand why a colleague behaves the way they do.

Some issues will be more difficult to deal with than others. Liz explains: "You can get conflicts charged with emotion, usually where people feel they are being bullied or discriminated against. These can be more challenging to resolve, but it’s important for a mediator to acknowledge and understand the emotion, then to strip the emotion out and to really identify the core issues. Emphasise the fact that whatever is said is confidential, and that you are not there to take sides or judge."

MOVING FORWARD

Once you are confident that you have identified the issues and that the parties have solutions in mind, the next step is to hold a (voluntary) joint meeting. Ground rules must be set about how the process will work and the mediator should make sure all sides are given a chance to speak. It’s important to carefully examine the options going forward rather than jumping to solutions too quickly. Break big problems down into small ones and highlight what could happen if the dispute is not settled.

Everything should be written down and solutions will hopefully be identified and agreed upon. The parties can then sign an agreement and decide how to move forward, including how to monitor the situation and ensure bad behaviours do not return – or that any agreed changes to systems or communication are undermined.

Liz says: "At the end of these meetings you should have a clear list of what has been agreed and how that will be achieved. It’s crucial to follow this up by arranging to meet again to monitor how things are progressing. You don’t want people to just go back to the way they were behaving before. If that happens, then carefully remind people what was agreed during mediation."

Some managers may find mediating a conflict too challenging and may be reluctant to take action for fear of jeopardising their own role within the practice. Others may find they do not have the necessary skills to tackle a serious dispute. But help is available.

Liz adds: "Addressing conflict can be a daunting process, especially for those managers who don’t have a strong influencing role within a practice. But try to deal with it early and seek support of other partners, GPs or GDPs to help you. If you still find it difficult, or if you think the problem is too complex for you to handle alone, then call MDDUS for advice or contact the BMA, BDA or a professional mediation service."

To find out more, the ACAS document Mediation: An employer’s guide is available online at www.tinyurl.com/2e3kk68

Joanne Curran is associate editor of Practice Manager