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Manager in the middle: keeping the peace in practice

18 July 2007

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Glenys Bridges

Managing Director
Training and consultancy firm

Glenys is a Chartered Member of the Institute of Personnel Development (CMIPD), and is managing director of a training and consultancy company, delivering qualifications for dental health teams. Her work brings her into contact with healthcare professionals from all sectors. She holds qualifications in management, teaching and life coaching, and is an author and columnist

Scenario one
Juliet is 35 years old and recently divorced. She has worked as an assistant at the practice for five years. She initially built mutually respectful relationships with the practice team and patients. Throughout her divorce, the reception team tolerated her aggressive responses when things did not go exactly as she would have liked.

However, now the divorce is finalised, her behaviour has deteriorated further, and patients are commenting on her lack of compassion, red eyes and the smell of alcohol on her breath. After receiving a very public reproach over a misfiled test result, a receptionist has approached the practice manager to complain about Juliet’s behaviour. What does the manager need to do to remedy this situation and prevent future reoccurrences?

Scenario two
Vishan is 45 years old. Last year, he took over as senior partner upon the retirement of his father, who had established the practice 40 years ago. His father was a highly respected GP, even although his style was aloof and autocratic. He took a no-nonsense approach and demanded the team had, as he did, a 110% commitment to patient care. Nevertheless, the team members who met his exacting standards regarded him as a fair and supportive employer.

Within a month of his retirement, Vishan’s father was involved in a fatal road accident. Vishan has had great difficulties coming to terms with the loss of his father. It has been noted that, at times, he has appeared agitated and restless. Last week, he barged into a diabetes clinic and demanded the nurse change a dressing for one of his patients immediately. He then became abusive when the nurse explained why she could not respond to his request immediately.

The nurse has made a formal complaint to the practice manager about Vishan’s behaviour, which she has termed “bullying”. How can you act to secure the best interests of all parties concerned?

I have often heard it said that to be an effective manager requires the wisdom of Solomon and the patience of Job. However, when managers rely wholly on their instincts and sense of fair play to resolve situations at times of conflict, they are more than likely going to make bad situations worse.

Every workplace benefits when established standards for an individual’s conduct and performance have been agreed. These should cover things such as timekeeping, absence, discrimination, addressing interpersonal conflicts, and will provide guidelines to acceptable behaviour. With these standards in place, it is possible for managers to address situations before they blow up into major problems that could ultimately involve outside bodies, such as ACAS (the Advisory, Conciliation and Arbitration Service).

Over time, people working in practice teams become much more than colleagues and, in Juliet’s case, the team have been supportive throughout her traumatic divorce. They have been prepared to overlook her aggressive responses, but now she has overstepped the mark, and the spirit of teamwork and cooperation is wearing thin.

All too often, the practice manager’s preferred approach to managing conflict between doctors and other medical professionals is to pretend the conflict does not exist, and make no attempt to resolve the root causes. This is unsatisfactory, as the issue will simmer under the surface and will most certainly re-emerge at the worst possible time.

Practice rules
Harmonious teams result from an environment in which everyone is treated with dignity and respect at work, and where bullying and harassment of any kind is not tolerated. This requires managers to provide objectives for teamwork, and define exactly what each person must do to achieve them – and, more importantly, what they should not do.

This can be achieved through the creation of a practice code. I have found an effective way to develop such a code is during a team meeting. Ask the team to:

  • Identify in their minds a person with whom they have really enjoyed working.
  • List the qualities that made that person pleasing to work with.
  • Conversely, ask them to identify and list the qualities of someone with whom working has been problematic.

The list of qualities each person produces will be remarkably similar, and they will have defined ways of interaction for the team to aspire to. With this in place, the team can work in the knowledge that, at times, each of them will fail to reach the most exacting standards, but that it is fair and reasonable for colleagues and managers to draw their attention to their shortfalls, and that team members must then work to rectify matters.

Addressing stress
The ability to manage conflict is critical to management success. Interpersonal differences are often fuelled by underlying stress arising from intensely personal issues. Managers need to be able to offer pastoral support, to prevent such issues from jeopardising the overall performance of the practice team, but must also be very aware that there is no going back once an issue has been discussed.

When you work in a team environment, what you know about others can shape your relationship irrevocably. If a manager finds that they are becoming too involved in the personal life of a colleague, they are advised to direct that colleague towards professional counselling – otherwise the manager risks becoming part of the problem him/herself. To identify the most appropriate helping format, managers need to:

  • Listen actively.
  • Observe as well as listen.
  • Help people to understand and define the problem by asking pertinent questions.
  • Get people to develop their own implementation plans.

Tackling scenario one
With respect to Juliet’s behaviour towards the receptionist, the manager needs to ascertain the nature and extent of the mistakes made on reception, to establish why mistakes are being made, and to work with reception to prevent future occurrences.

The manager’s approach towards Juliet should include the senior partner, and  should take the nature of “an iron hand in a velvet glove” – ie, showing her empathy while requiring her to observe the agreed practice code of behaving with respect and courtesy toward colleagues.

It would be unhelpful not to mention the concerns with respect to her smelling of alcohol. The practice should have agreed protocols in place for providing a supportive environment for any team member who finds that they are unable to control their intake of alcohol to an extent that their work is compromised.

It would be useful to draw her attention to the General Medical Council’s (GMC) guidance for doctors, which can be downloaded from the GMC website (see Resources). If the alcohol problem persists, the manager could ask Juliet to take advice from the Sick Doctors Trust (SDT), an independent organisation, founded in 1996, which runs a 24-hour, confidential helpline for actively addicted doctors who may not have sought help (see Resources). The SDT was set up for doctors by doctors who have experienced and resolved such problems.

Tackling scenario two
In the second case, it is the behaviour of the senior partner, Vishan, that is the problem. Here, the manager needs to prevent the practice finding itself before an employment tribunal. Employers must follow regulations aiming to shape their relationship with employees, avoid harassment, discrimination, and define ways to address performance issues by setting clear and consistent performance criteria. Failure to do so may just cause unpleasantness or irritation, or in the worst cases can lead to an internal complaint or legal action.

When a problem occurs, managers need to enable both parties to address the relevant issues. Using the practice “grievance procedure” may well be the best way to do this. Grievance procedures are a means of dispute resolution that can be used to address complaints by employees against managers. The best-known application of grievance procedures is as a formal process – the term “grievance”, as it appears in the written contract, refers to a formal complaint by people who believe that they have been wronged.

Grievance procedures do not necessarily have to be formal and elaborate. In small businesses, the procedures may consist of a few lines in an employee manual, or the designation of a single ombudsman to deal with problems as they develop. Peer review of employee concerns is another popular way to address grievances.

A typical grievance procedure begins with an employee presenting a problem to his or her practice manager within a certain time period after the offending event has occurred. The manager then has a set amount of time to either respond or send the grievance on to be addressed by the employer. If the situation cannot be resolved, the final step in the grievance process is for both parties to consult an arbitrator, such as ACAS. The arbitrator’s role is to determine the rights of both parties. The arbiter’s decision is usually final.

From a pastoral point of view, the manager needs to give consideration as to why Vishan is alienating his colleagues. As healthcare professionals, they are all aware of how individuals come to terms with the loss of a parent, especially when that parent had set uncompromising standards for home and professional life.

Vishan had relied heavily on his father for advice and guidance, but now finds himself without his lifelong mentor. He needs to build his confidence in his ability to be a successful team leader, working within the management guidance for doctors laid down by the GMC (see Resources).

The practice manager’s responsibilities are to create a working environment in which healthcare professionals can do their very best work for the benefit of patients. The skills needed to achieve this include the ability to balance the needs of individuals with the best interests of the practice. It is simply not possible to achieve this fine balance without a robust framework of policy and protocols to base their decisions and actions upon.


General Medical Council

Management for Doctors – GMC guidance

Sick Doctors Trust