Conflict

Meet Drs. Andy and Ben. (these aren't their real names, but this is their real story.) They're long-time friends, classmates, who want to start a practice together. They appreciate each other's skills and believe they'll work well together as business partners.

Dr. Andy is methodical, organized, and focused on getting things done. Dr. Ben is a creative thinker and a visionary, always looking ahead for new opportunities. So Drs. Andy and Ben embark on a journey together. They purchase land, build a facility, and hire staff members. They're about to live their dream.

But it wasn't a dream at all. Their practice turned into a nightmare. Two years later, Dr. Ben calls me. "Things aren't going well," he says. "Dr. Andy and I just don't see eye to eye. I want out of the practice. Can you help me?"

I wish I could tell you their story has a happy ending. It doesn't. The truth is I couldn't help. Their conflict had turned the practice on end, resulting in severe turnover and a declining client base. Both doctors had considered filing bankruptcy because they couldn't cover their mortgage payments on the practice property. They ultimately went their own ways. How could conflict get so bad that it literally tears a practice apart?

Drs. Andy and Ben let their differences generate conflict from Day 1, and they did nothing to stop it. Of course, not every disagreement results in conflict. In fact, most disagreements are constructive. They're a natural part of interacting with others and serve as a catalyst for positive change. What differentiates disagreements from conflict is how the participants choose to deal with them.

Drs. Andy and Ben chose not to deal with disagreements at all. Dr. Andy says that Dr. Ben always wanted everything to be nice and pleasant and for everyone to be happy. "He wouldn't talk about our problem," he says. "He thought it would go away by itself."

Meanwhile, Dr. Ben says confrontation made Dr. Andy uncomfortable. "As a result, our differences took on a life of their own, killing our practice," he says.

What started as complementary strengths surfaced as differences in the doctors' working styles, and unaddressed, they led to disagreements. These disagreements led to conflict for several reasons:

• The doctors were interdependent; each needed something from the other.

• They blamed each other, each one finding fault with the other for causing the problem.

• They were angry, whether the emotions were hidden or open.

The owners' behaviors also caused business problems. Their relationship with each other, their staff, and their clients suffered, resulting in costly mistakes and delays. Everyone spent time dealing with stress and anger. Everyone's productivity dropped.

The downward spiral

In my consulting work, I often see the results of unresolved conflict. The emotional energy required to suppress conflict takes time, effort, and compassion away from clients and patients. So the effects of the conflict reach beyond those directly involved.

For example, two doctors operating in conflict mode who can't agree on standards of care, such as when they'll require preanesthetic lab work or when they'll recommend six-month exams instead of one-year exams, can be divisive at the staff level. Who's lead does the team follow?

When callers ask about a practice's vaccination protocol, I've heard receptionists say, "It depends who your doctor is." And if there are six veterinarians in your practice operating in conflict mode, your receptionist must learn six answers to every client question. Staff members no longer know the definitive answer and they start questioning everything.

Our code of conduct guides the way

The symptoms of unresolved conflict don't stop with poor recommendations. Consider these other ramifications:

• Loss of clients. Clients wonder, "If they're treating each other that way, how are they treating my pet?"

• Burnout. You realize, "I just can't deal with the stress and tension any more. I hate going to work."

• Loss of staff. They decide, "I don't need this in my life; I'm quitting."

• Practice breakups. Your partner realizes, "I can't work with you anymore; it's effecting my physical and mental health and my family."

• Medical mistakes. You or your team members' minds are elsewhere.

The effect on the bottom line

Of course, conflicts engender some unquantifiable costs—the emotional toll on you and your family and the loss of friendships, for example. There's no easy way to figure these costs, though they can be high. Direct costs of such conflict include fees paid to mediators, attorneys, or other professionals. And you need to consider productivity costs, including lost time and inefficiencies.

Out of control? Take swift action

How many hours per week do you spend on conflict in your practice, and what's the price tag? That's exactly what Dr. Andy wanted to find out. Here's what he looked at:

• Wasted time. Dr. Andy estimates that he and Dr. Ben spent at least four hours a week arguing unproductively. Given their annual pay of $80,000 each plus benefits, their downtime cost the practice $320 a week for each week the conflict remained unresolved, or $16,640 a year. Plus, Dr. Andy knows the staff spent time talking about their arguments; he had even heard them taking sides. With eight staff members, that's another $560 a week for an annual cost of $46,000.

• Poor decision-making. To make good decisions, you need good information. Most of the information used to make decisions comes from co-owners or employees. With poor communication, things slip through the cracks.

For example, Dr. Andy asked his favorite technician to research a software system that he wanted to buy. The technician's recommendation resulted in a purchase. Meanwhile, a technician loyal to Dr. Ben knew from experience at a prior practice that the software wouldn't meet the practice's needs but didn't share her knowledge. After the software was installed, Dr. Andy found that it didn't suit the practice. Six months later, they replaced the system at a cost of $18,000.

• Loss of collaborative efforts. After the software episode, the technicians involved wouldn't work together. Both owners and staff members spent significant time rearranging the surgery schedule and contacting clients to reschedule so that the technicians wouldn't be at the practice at the same time. All in all, time spent totaled about 10 hours, or $265.

There was an added loss, too. Keeping two very talented technicians away from each other reduced opportunities for collaborative problem solving and creativity, which could make the difference in saving a patient's life.

• Reduced motivation. Dr. Andy estimates that everyone's productivity dropped by at least 5 percent because of the ongoing conflicts. Price tag: $22,000 a year.

• Employee turnover. It takes six to 12 months to replace a competent employee and get a new one up to speed. The cost of turnover is easily a year's salary for every productive employee that leaves the practice. Based on the clinic's average annual employee salary, that's another $30,000 per employee through the revolving door.

When Dr. Andy tallied all these costs up per year, he reached about $146,000. The practice was spending almost as much on conflict as it was on the doctors' salaries. And that's not everything. Dr. Andy could have continued to add in costs from absenteeism, health issues, and even employee theft that could be traced back to their unresolved disagreements.

Identify the problem to put a stop to conflict

Drs. Ben and Andy had a choice, though. They could have stopped the downward spiral that conflict was causing in their practice. While it's too late for them now, it's not for you. If you know you've got conflicts to resolve, start by identifying the source. You'll likely find that it started when:

Adding up the costs

• You lost sight of your practice's purpose or even why you became a veterinarian in the first place. Without clarity of purpose, when differences or disagreements arise, you'll have no guiding light for resolving them amicably. Eventually, no one in your practice will remember that your decisions were always based on your mission to care for patients.

Protocols for harmony

• You hired staff members who didn't share your values and lacked the qualities you know are critical to the success of your practice. Without shared values, you won't enjoy a shared understanding of which behaviors are acceptable and unacceptable.

• You kept your practice culture to yourself, not sharing the ideals and goals that guided you to where you are today. If everyone isn't headed in the same direction, you may not be delivering the best care and service to your patients and clients.

Jim Collins, the author of Good to Great: Why Some Companies Make the Leap ... and Others Don't (Collins, 2001), talks about this concept in terms of getting the right people on the bus. If you have talented people on the bus who believe in your culture and philosophy of medicine—your practice—and you have the wrong people off the bus, then you can take the bus someplace great. And you can change directions as needed to adapt to your changing world.

• You became unwilling to address differences. Without resolutions, differences escalate and multiply. Avoiding conflict at all costs just creates more conflict.

• You let personal rights and entitlements come first. When anyone on your team decides that the practice exists to serve his or her personal needs, the patient and client no longer come first. When this kind of attitude ignites, when people focus on what they can get and compete with each other for what they see as their entitlement, it can spread like wildfire.

When you see these situations crop up in your practice, stamp them out immediately. To help get back on track and to prevent future problems, consider instituting a framework—I like to call them "Protocols for Harmony"—for addressing differences that arise.

The lesson of unhappy endings

As I mentioned, the conflict between Drs. Andy and Ben had gone too far. Unfortunately, the cost turned out to be unaffordable. The owners split and moved to different parts of the state. Today, they are sole owners of their own practices. They have no contact with each other. And they've lost a friendship that was important to them.

I hope you never experience a similar situation, especially considering how avoidable it is. Remember, most disagreements are constructive—they serve as a catalyst to positive change. When disagreements are addressed, they bring everyone's attention back to the practice's purpose, putting everyone back on track with renewed enthusiasm. Think of disagreements as an opportunity for learning and personal growth. Is your practice prepared for the opportunities that are coming its way?

Cynthia Wutchiett

Veterinary Economics' Financial Editor Cynthia R. Wutchiett, CPA, is president and co-owner of Wutchiett Tumblin and Associates in Columbus, Ohio. Please send questions or comments to: ve@advanstar.com