Our Managing Director writes about how to ease tensions within a private practice. First published in Independent Practitioner Today.

Tensions are not uncommon when consultants get together to form groups in private practice in the current financial climate. Our Troubleshooter Jane Braithwaite tackles an appeal for help. 

‘We have been working in a group for two years now and we are starting to experience tensions between us. How do we manage these tensions without breaking up the group?’ 

Running a busy private practice group can be rewarding but time-consuming at the best of times. If you are experiencing disagreements with the other members of your group, it can feel overwhelming.  

Tensions, disagreements or even arguments can be common, especially among the high-performing clinicians that make up your group. 

This article will look at how to approach your colleagues to diffuse this tension, how to reduce the chance of divisions going forward and what steps to take if you feel the situation is irretrievable and the group needs to be dissolved. 

There are a number of steps you can take to resolve this situation. 

Tensions are common  

The nature of a group can lead to building tensions. It is rare that everyone in the group has exactly the same goals, both professionally and personally.  

These slight differences in objective can lead to stress, which can manifest in many different ways. 

The reasons for these disputes vary from person to person and from group to group. They could be related to individual financial problems, the clinical direction that the group is moving in, the way work is allocated or how profit is distributed.  

Whatever the cause, it will be essential to see the problem from everyone’s point of view in order to come to an amicable solution. 

How to start the discussion 

The process of understanding the problems within the group and addressing them is key.  

One of the best methods is a meeting to talk through all the issues. Everyone must be present, because if someone feels excluded, it may lead to resentment and the underlying problems cannot get solved. 

At the outset, you should set the expectation that these meetings are the forum to talk through all the tensions, with no side discussions or confidential chats that do not involve all members of the group. 

This meeting aims to bring up all the problems that people feel are holding the group back, work together to find a solution and decide how it will be implemented. 

How to structure the discussion 

If you lead or manage the group, you may feel it is natural that you take charge of this meeting.  

Depending on what needs to be discussed or what the underlying issues are, the other members may find it more difficult to be open and honest if one person appears to have more sway than the rest. 

To ensure that there is no power imbalance in the discussions, you might find that having an independent person to chair the meeting can help things flow a bit better. They can help keep the meeting on topic and make certain that everyone is having their say. 

If you have significant problems within the group, it is likely that this meeting will involve a degree of confrontation.  

This is never a comfortable position to be in, both for yourself and others. Going into this meeting prepared, either by having thought through what needs to be said or bringing notes with you, will make sure that you can manage to get your point across. 

Psychologist Bruce Tuckman described the stages that teams go through when working on a project together. He named these stages ‘forming, storming, norming, performing’.  

The ‘storming’ stage is characterised by potential conflict between members as everyone tries to work out individual roles and pushes against boundaries. 

It may be that, as a group, you have entered the ‘storming’ stage, with its uncomfortable conflicts, and that you need to work through to reach ‘norming’, where everyone resolves their differences, and ‘performing’ where members work together to achieve the group’s goals. 

If you can push together through this difficult stage, you may find that you have bonded better as a team and can attain greater success in the future. 

How could the process go wrong? 

Any situation involving confrontation is fraught with pitfalls. 

If relationships within the group are already fractured, there may be considerable resistance to bringing about the meeting. Sometimes in these circumstances, there is one member of the group who can act as a ‘peacemaker’ and bring the others together. 

It can be tempting to phrase all communications about these meetings in hard-nosed business language. By humanising what you say and acknowledging your own and others’ discomfort with the situation, you might find that everyone can open up a bit more about the problems that they see. 

Some people may find this level of discomfort and confrontation intolerable and, rather than face the issues, may choose to leave the group. 

 If there is no way to bring about a meeting between members, then the business relationship, and thus the group itself, may not be salvageable. At this point, the advice of experts such as lawyers and accountants will become invaluable. 

How can we improve in the future? 

If you have managed to have these discussions, then you have taken a difficult but important step for your business. It would be a shame now to slip back into your old ways and find that the same problems and conflicts are continued. 

Look back at the contracts and agreements that you had drawn up when you formed the group. Do these still reflect the way the business is run? You may find that you have altered some of the roles, responsibilities and functions of group members and may wish to put this down in writing in new contracts. 

You will need an agreed structure for the future and this should be documented and signed by all members of the group.  

If necessary, you should seek advice about drafting these new contracts and agreements to make sure that everyone has clarity about what they can expect of others and what others will expect of them. 

Ongoing communication will be essential, perhaps in the form of a monthly group meeting. This will provide a forum for issues to be aired while they are still small and easily solvable and allow them to be dealt with before they become a threat to the group. 

What if the group cannot be salvaged? 

Sadly, it is not uncommon for dis­agreements to snowball, ending up with a break-up of the group.  

If your founding agreements included provisions for dissolving the group, then this process will be much easier. 

If the initial contracts did not cover this, then it will be necessary to negotiate with the other members of the group to find an amicable way to split the assets. This could be complicated and having the advice and input of experts as early as possible is advised. 

Managing conflicts, tensions and disagreements in a group can be difficult. If you can find a way to bring everyone together as a team, where each individual is empowered to raise problems, you may find that the resulting group functions much better than before. 

If you have any specific questions that you would like answered in upcoming editions, please do feel free to get in touch. 

Info@designatedmedical.com or call 020 7952 1008

 

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