From Conflict to Collaboration: Overcoming Challenges with Your Staff

An earlier version of this article appeared on this website in February, 2024

As a cardiologist in practice for nearly 30 years, I was fortunate to work alongside a fantastic team of nurses, medical assistants, and office staff. I give much of the credit for our success to our no-nonsense in-house nurse manager. She was firm but kind, and her extensive hospital experience meant that she knew her stuff. But not all physicians are so lucky. And even one difficult staff member can make going to work draining and dispiriting.

Although medical training involves teamwork, you probably completed med school and residency without any real preparation in business, leadership, or personnel management. That means that if you’re like most physicians, you’ve been left to figure it out on your own. If you’re learning on the job, getting off on the right foot can impact your experience at work for years to come.

Until my practice was acquired by a larger organization, I served as chairman of our Human Resources (HR) committee. I also served on hospital committees over the years that dealt with professional standards and conflict resolution.

My experience provided me with valuable lessons and an insider’s view into the complex issues of a large group. So if you’re a physician dealing with challenging staff members, I’ve got some expert tips and insight to help you manage conflict effectively and foster a healthier, more collaborative workplace.

Physician-Staff Relations: Navigating the Landscape

First, a little perspective. In years past, most physicians owned their practices. So in these situations, the physician or a trusted administrator typically did the hiring and firing. And the staff understood that keeping up good relations with their physician-employers was vital to maintaining happy employment. Some independent practices still work that way.

But now that most physicians are themselves employees, the lines have become more blurred. And the truth is that depending on your organization, you may or may not have much say in the way the practice is run.

That doesn’t change one essential fact: your leadership shapes the culture of your practice. Whether it is explicitly stated or not, your staff is there to support the important work that you do. And that translates into creating a workplace that provides a welcoming, safe experience not only for your patients but for the team members themselves.

To your patients, your employment status is irrelevant. They see your staff as an extension and a reflection of you. If the practice feels chaotic, unfriendly, or unsafe, that reflects back on you,

Turning Staff Challenges into Opportunities

Most people who work in healthcare take pride in their jobs and care about the people they serve. But, as in any line of work, it’s almost inevitable that you will encounter some challenging folks along the way.

When dealing with the inevitable conflicts and other tough situations at work, here are some important things to keep in mind.

💊Don’t Make it Personal

When things get sticky, it can be tempting to let your emotions take over. But here’s the hard truth: the minute you make it personal, the problem becomes about you. This can be very difficult if not impossible to turn around. By keeping it professional, you have a much better chance of remaining above the fray.

💊Create a Supportive Culture

Respect flows both ways, and workplace culture matters. When you show staff that you value their contributions and care about their well-being, they’re more likely to respond with cooperation and respect.

Commit to knowing your staff by name, including the people at the front desk. Simply recognizing them as individuals can go a long way towards creating a warm and supportive workplace. Don’t ever forget that your staff are often the ones who create the first impression of your practice for both your patients and your referring physicians.

Small gestures of recognition can also make a big difference, as long as you’re careful not to play favorites. Examples might include a simple thank you for handling a difficult patient with compassion, taking time to listen with presence to a staff member’s concern, or offering opportunities for growth and advancement.

💊Respect Boundaries

Avoid favoritism, blurred boundaries, and personal entanglements. When you spend most of your life at work, it may be tempting to see your staff as friends. This is a pitfall that many early career physicians fall into.

Over time this can create divisions and expectations that can make the workplace more complicated and stressful. These kinds of issues can spiral out of control very quickly, even when your intentions are innocent.

It’s not uncommon for HR to step in under these conditions, and it doesn’t always go well for the physician. By maintaining clear, friendly but professional boundaries you’ll protect both yourself and your team.

💊Offer Solutions and Set Expectations

Depending on the issue, it may be your responsibility to work with the staff member to resolve the problem. This is often the case for minor procedural problems, lack of education, and misunderstandings.

If the issue is skill-based, offer training, support, or feedback, when appropriate. If needed, advocate for continuing education. Be explicit about your expectations and provide regular check-ins so that the benchmarks are clear. Many struggling staff members will become loyal allies when they know you’re invested in their success.

💊Be Direct, Clear, and Honest 

When meeting with a staff member who has been disruptive or underperforming, approach the conversation calmly and clearly. Focus on how the issue affects teamwork and patient care.

If possible, have a nurse or trusted colleague present for the discussion, even if it seems like a simple situation. That can add a layer of protection for you as well as accountability for the person you are meeting with.

Lead with an intention of collaboration, and whenever possible, avoid being confrontational or accusatory. An attitude of respect and empathy can go a long way toward building trust and strengthening teamwork.

💊Document everything

Keep detailed notes of disruptive or dangerous behavior: dates, times, specific incidents, steps you took, and any witnesses.

Documentation is not only about building a case. It is also critical for protecting yourself, your patients, and your other staff members.

💊Seek the Root Cause

Your practice’s administration is likely responsible for managing dangerous, inappropriate, or disruptive behavior. If you’re employed, that’s probably not your job. But getting a handle on the behavior and its root cause can be helpful. Understanding the “why” doesn’t excuse poor behavior, but it can help you depersonalize the problem and think more strategically about solutions.

That perspective may also point toward a path forward. With greater insight, you’ll be in a stronger position to work collaboratively with your administration on lasting solutions.

💊The Benefits (and Risks) of Involving HR

If you have access to an HR staff member or administrator, and you feel reasonably confident that they will support you, it is sometimes best to involve them early on in a difficult situation. This can help to protect you from accusations of harassment or favoritism.

That said, remember that if you are employed, HR’s ultimate responsibility is to the organization, and not to you as an individual physician. This means that their priorities may not always align with yours.

In some cases, involving HR can even make matters more complicated. Before you take this step, weigh the risks carefully, be clear on the issues you are dealing with and know the outcome that you are hoping for. Consider talking with a trusted colleague in your organization first, to get some perspective and see if the situation might be better managed directly.

Still, when the problem involves legal risk, patient safety, or repeated disruptive behavior, don’t take on this burden. In these cases, HR should be part of the conversation so that appropriate steps are taken before any harm is done.

Leadership That Builds Trust

As a physician, you have the right to expect a positive and productive working environment. If a staff member is making it challenging for you and others to do your jobs, it’s critical to take the necessary steps to ensure a safe and effective workplace.

Whether that means prescribing additional training, involving administration, or, in some cases, parting ways with a disruptive employee, the key is to lead with calm professionalism. When you embody consistency and clarity, you help create a workplace where staff thrive, patients feel safe, and you can focus on doing your best work.

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Learning the Art of Delegation: A SMART Tool for Physicians

An earlier version of this article appeared on this website in July 2023.

Delegating can be a challenging skill for many physicians to master, but it’s often an integral part of safe and efficient patient care. The need to maintain control over every detail—especially when you bear ultimate responsibility—can make letting go feel risky. That’s why the most effective delegation is not just about offloading tasks; it’s about empowering your team to work at their best.

In this article, we’ll explore which tasks are most suitable for delegation, how this practice can strengthen teamwork, and strategies to make the process efficient and effective. Plus, I’ll share a practical template to help you overcome common barriers, enabling you to maximize your team’s potential.

Of course, you can’t (and won’t) simply assign a task and hope it all works out. Instead, when you delegate, the goal is to get the same or better result than if you did the task yourself.

As a physician, there can be a blurry line between what you need to do to assure the optimal care for your patients and what others must do in order for you to accomplish your best work. Creating a cohesive team mentality will help you to reach these goals with greater confidence.

Begin with creating clarity around responsibilities and purpose. You are the team leader. The goal is to provide the best and most timely care for your patients, and to administer that care with compassion and professionalism. By establishing clear and well documented instructions and expectations, you’ll set your team members up for success.

You may already know about SMART goal setting, but the SMART Delegation mnemonic is a distinct tool designed to help you manage your workload more effectively and make the most of your time. By following its steps, you can delegate tasks successfully while empowering and motivating your team to perform at their best.

 SMART Delegation

(Based on the work of Kate Christie of Time Stylers)

SELECT: Choose the best person for the task. This may be someone with little experience but a willingness to learn, or it could be someone with years of practice in the same or related field. Be choosy, but consider thinking outside the box.

MOTIVATE: Motivate your team by explaining why the task is important. This will create buy-in and a sense of importance and pride. This step is important to revisit periodically, especially at first.

ACTIVATE: Explain the details of the task in detail. Be sure to include a checklist if appropriate, and a written guideline that can easily be referred to and updated as needed. Once you put in the work to create the guideline, this bit of heavy lifting is done. This is a crucial part of time management.

RESULTS: Describe and explain clearly what a good result looks like. Be sure your delegated team member understands the purpose of their work, and how to recognize common complications.

TIME FRAME: Set realistic but firm deadlines when implementing new protocols. Consider setting up a mid-point check in if appropriate.

What to Keep in Mind When Delegating

Trust but Verify

Delegation requires trust in your team, but it’s also essential to check in periodically to ensure the task is on track. Verifying progress not only helps catch potential issues early but also reinforces accountability and builds confidence in your team’s ability to meet expectations.

Acknowledge the Learning Curve

Remember, your team or individual members may be learning a new skill. Take time at the outset to be available, approachable, and patient—especially in the early stages. The time you spend now will be paid back in multiples once the process is clear. Ensure the person taking on the task fully understands their role and the expectation that they will eventually handle it independently in most cases.

Keep Communication Open

Maintain open lines of communication so your team feels comfortable seeking help with complications or unexpected situations. Whenever possible, turn their questions into teaching opportunities instead of simply providing answers. Foster a spirit of teamwork by encouraging them to brainstorm solutions and come to their own conclusions, while also offering a safety net of support.

Utilize Supervisors as Needed

If appropriate, involve a supervisor to provide additional support. This allows your team members to seek guidance on minor issues or questions without always relying on you. It also brings the supervisor into the process, building camaraderie by acknowledging their role and creating stronger team cohesion.

Provide Constructive Feedback

Be generous with your praise and constructive criticism. Patience is essential, but if someone consistently struggles to meet expectations, consider delegating the task to someone better suited for it. Avoid slipping back into the time-consuming habit of doing everything yourself.

Embrace Discomfort

Delegating can feel like relinquishing control, so it’s normal to experience some discomfort at first. Be patient with yourself and your team while setting clear and achievable expectations.

The Ripple Effect of Effective Delegation

When you commit to the principles of SMART delegation, you’re not just easing your workload—you’re fostering a culture of trust, accountability, and growth. With the right people and processes in place, delegation can make you more productive, improve safety, strengthen teamwork, and enhance patient satisfaction.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.