by Sandy Roth
As the team assembled for their monthly meeting, Dr. Winchester reviewed the agenda. This time, she was determined to get through the meeting and actually accomplish something. Everyone had the same complaint: they talk and talk, but nothing ever changes. It was her complaint, too. Dr. Winchester didn't mind the time these staff meetings took. In fact, she wished they spent more time discussing and resolving issues. But the meetings never seemed to get anywhere. Some of the staff would speak up and dominate the meeting, while others sat passively, without contributing or participating. A week after the meeting, things would revert to business as usual.
Which problem should she choose to address? "An easy one," Dr. Winchester thought to herself. As she reviewed the list, however, she came across the item, "Inventory, Ordering, and Stocking." Uh-oh. This problem had been going on for weeks and she couldn't figure out why. Before Jodi left, the system had worked perfectly. They never ran out of anything. Supply costs were within budget. Operatories were well stocked at all times. In fact, it was a non-issue. But Susan, and Jim, the new assistant, couldn't seem to get their acts together. They argued about who was to do what and accused each other of using the last of items without recording the depletion of stock. Lately, they just walked around each other, barely speaking. It was getting everyone down. Yes, this would be a good place to begin. She would insist that they find a way to make the system work.
The meeting, however, was a disaster. Although it started well, it quickly deteriorated into a shouting match. Susan and Jim couldn't agree on anything; Dr. Winchester was surprised at the intensity of their exchange. Jim accused Susan of not carrying her weight. Susan blamed Jim for broken instruments and wasted materials. Accusations flew. Both were defensive, and neither gave an inch. Dr. Winchester's attempts to facilitate the discussion only made things worse. "Okay, let's put aside these disagreements and see if we can fix the problem. It ought to be simple. After all, it's just a bunch of stuff." Or was it?
Dr. Winchester does have a problem, but it isn't what she thinks. What seems so easy to deal with from the outside is rarely as simple to those involved. Emotions interfere with the ability to address issues, a phenomenon that is hardly unique to dental practices. Consider the following examples:
- A bitter divorce is followed by years of continuing battles over child custody, visitations, and birthday parties.
- A razor-thin margin of victory prompts lawsuit after lawsuit, challenging everything but the weather on the day of the election.
- A dental partnership breaks up and you could cut the tension with a knife.
Although the facts of these situations seem straightforward, the emotional element takes them to another plane. Fair custody and visitation plans are possible, but the anger and rancor that can accompany a divorce blocks the parties from focusing on fairness.
Perhaps you can recall a dental partnership that suffered from the same malady. Differences in perspective, style, or clinical approach compel one good person to dissolve a partnership with another good person. But the emotional impact of such a decision often makes it impossible for the breakup to happen without negative repercussions. Tensions are high and arguments are many. Staff members are polarized and the situation deteriorates beyond redemption. The costs of bickering can be enormous.
Each of these situations, as well as Dr. Winchester's, is an example of the principles at the center of this month's article.
Conflict: what's really behind it?
Effective problem solving cannot occur until conflicts are resolved. Many problems exist in an environment of ongoing conflict. It isn't simply the system or the structure that must be re-evaluated; it is the emotions of the people involved. Most people resist addressing conflict. Layers of anger and frustration often build beyond the ability to dissolve them without a major confrontation. Here is an example of how this works.
Joan has worked in your practice for several years. She is a competent and hard worker. Because of the other, less competent, staff around her, she has put some much-needed systems in place with your encouragement and approval. These systems thwart errors before they reach patients; they require Joan's continual oversight and supervision.
Due to staff turnover, you hire Connie, who is bright, energetic, and skilled. From the beginning, Connie and Joan clash. Connie chafes under Joan's micromanagement, while Joan resents Connie's alternative strategies and resistance. Within three months, the situation is explosive. These two intelligent women seem incapable of resolving their issues.
Successfully solving this problem is impossible until we understand the exact nature of the underlying conflict that caused it. In this example, Joan's sense of worth is heavily tied to the systems she created. Connie's sense of worth, on the other hand, is tied to her ability to perform without close supervision. To meet Connie's needs, Joan must give way, or vice-versa. The real cause of the problem is the failure to anticipate this situation and help Joan learn how to work with more competent staff. Joan must redefine her role and establish her worth in new ways.
But conflict is paradoxical; those who avoid addressing conflict are more likely to experience it than those who are willing to take on issues when they are small. The more threatening the situation, the more intense the conflict. One would think that the intensity of a situation would prompt action, but that isn't always the case. Because so many people are seriously conflict-adverse, intensity actually decreases the likelihood that fearful folks will take on the issues, thus delaying resolution.
Likewise, the more long-standing the conflict, the less likely the parties will address the issues. Little problems go unresolved for trivial reasons — "I don't want to hurt her feelings" — until they build up a head of steam. Mild annoyance becomes major disgruntlement; those who are conflict-adverse typically choose to triangulate rather than address issues head-on.
Triangulation is the preferred style of handling conflict in many teams. One person has an issue with another, and expresses her frustration to a third. The army grows, thereby amplifying the negative behavior out of proportion. Before long, no one can break ranks to address the situation because the parties are more invested in preserving the unity of the opposing forces than resolving the problem in the first place. (This phenomenon can be seen in international skirmishes throughout history, so don't feel that it belongs in the dental practice alone.)
Sadly, factions within teams can co-exist under these circumstances for a very long time. The longer these situations go unaddressed, the less likely the bad feelings will ever be cleared.
Conflict itself is not a destructive force, but conflict left unaddressed is. Conflict is as necessary to the human condition as the air we breathe, for nothing would change without it. Innovations, new ideas, creative processes, and growth all result from conflict between what is — and what we want to be. But unaddressed conflicts create mistrust, suspicion, dishonesty, defensiveness, conspiracy, and barriers. Without question, problems cannot be solved when:
- People mistrust one another's motives or ethics
- People are secretive, thus arousing suspicions
- People are dishonest or suspect dishonesty in others
- People are defensive and unwilling to look at the role they play in a conflict
- People conspire to place themselves in a good light at another's expense
- Barriers form and are allowed to remain unchallenged
Too often, dentists and their teams fail to understand what is actually going on and thus choose a tactic or strategy that does not adequately fit the situation. Just as discovering and understanding the cause of a patient's problem is essential to creating an appropriate treatment plan, the cause of practice problems must be discovered and addressed to properly deal with the underlying issues. Otherwise, the emotional issues that cause conflict will simmer and fester to an unhealthy level, making them even more complicated and costly to solve.
So, you must be prepared to address the emotional issues first to gain the needed insight to address the remaining problems. When conflicts are successfully resolved, many problems virtually evaporate. This is because the problems were caused by the conflict — not the cause of the conflict.
Conflict resolution takes many forms, and they are readily available to anyone who cares to search them out. (If you would like a simple model to use, send me an email that includes your name and address to firstname.lastname@example.org.) When selecting a method, be clear in the fact that resolving conflict is first and foremost about creating an environment safe enough for people to identify their emotional issues and discuss them with others. This almost always requires the help of an outside facilitator, one who has no investment in the outcome. Facilitators can ensure the safety of each participant and keep the process moving.
It is difficult if not impossible for a team member to facilitate conflict resolution. For one thing, each member plays a part, by omission or commission, in the creation and perpetuation of conflict. Therefore, everyone must be a shareholder in its resolution. It requires a level playing field; each person must acknowledge the part he or she played. A facilitator can help identify where relationships are damaged and help each team member discover what remedial efforts will be necessary. Remember, this is not an intellectual or academic exercise. It is an emotional one. Clear the baggage and address the conflict first. Then, you can move on to solving the remaining problems.
To learn more about how you and your team can develop stronger and more effective communication skills, call Sandy Roth at (800) 848-8326, or send her an email at email@example.com to request a catalog of learning resources.
Guided personal exercise
This month, I've given you an exercise to help you distinguish between problems and conflicts. This may be challenging for some team members, so it will be important to create a safe environment. Begin by inviting each team member to respond privately to these questions, before the team meeting:
- What agenda items seem to reappear?
- What topics have we discussed several times without anything changing?
- What problems do we seem to never get beyond?
- What are the barriers to solving those problems?
- Which of those barriers have to do with people and relationships, rather than structure, systems, and equipment?
- What issue has bothered you for some time that you have not raised with the entire group?
- What are you ready to discuss now? What are you not ready to discuss now?
Once team members have completed their preparation, meet together to discuss the difference between problems and conflicts. If possible, have an outside facilitator join you for the meeting. Allow each team member to report what she or he listed, either in random order or by moving around the room. Writing responses on a flip chart helps.
See what you have in common. Ask yourselves why this is the case and work to discover what part of each issue is clouded by conflict. Then, go on to the next question and repeat the process as long as your team is able. If necessary, schedule a second meeting. Each time you readdress the issues, you will get through more. Continue working until you can discuss your conflicts openly.