No matter how close your business and professional relationships with your partners, at some point or another you’ll likely have some disagreement or conflict. While some groups start talking break-up over seemingly benign situations, others manage to cope and thrive through mergers, leadership issues, and contract negotiations with barely a ripple. They manage change well, usually seeing change as an opportunity. Here are our ten commandments for practice harmony:

First Commandment. Thou shalt set clear expectations. That includes discussion about everything from productivity to goals to personal and professional beliefs about the practice’s commitments. What are our expectations? What do we, as a group, believe in? Is it clear to our patients, our referral sources, and anyone else we are negotiating with or will deal with? You need a written version of your Principles of Practice that is revisited as you make major decisions. Make a realistic commitment to prevent a toxic practice.

Second Commandment. Thou shalt set regular opportunities to talk about divisive issues or conflicts that are not resolved. This doesn’t mean catching a partner in the hallway and chewing him or her out about the call schedule. It means setting aside a portion of every partner meeting – or even holding special meetings – to clarify potentially disruptive issues such as defining fair call schedules, vacations, compensation, productivity, and sick call.

Third Commandment. Thou shalt turn to a mediator when necessary. A neutral unbiased, third party -- not connected with the practice -- can make an enormous difference in resolving conflicts between partners without creating the potential for ill feelings or resentments. Make sure the person you turn to -- whether volunteer or paid -- is comfortable, and/or trained in mediation.

Fourth Commandment. Thou shalt ask, “How am I doing as a partner?”  Periodically ask, “How could I be a better partner or colleague, and how am I doing?”  A partnership is like a marriage or an extended family; if you don’t work at it everyday, it won’t work well.

Fifth Commandment. Thou shalt ask every week, “What is interfering with our ability to meet our goals and objectives?” Is it lack of trust? Is it lack of competency -- and in what arenas?  Is it a lack of skilled personpower? Is it a lack of leadership and focus? Are the leaders overwhelmed?

Sixth Commandment. Thou shalt ask each week, “How well is the group fulfilling its vision and mission?” It is essential to know what the mission and vision are. The vision needs to be shared enthusiastically by your colleagues.

Seventh Commandment. Thou shalt learn and practice conflict resolution. Preferably, conflict resolution is ingrained so that its practice occurs before intransigent conflicts arise. This may mean special training and exercises to enhance the training every few months. Constantly ask yourselves, “How are we doing at resolving disagreements?”

Eighth Commandment. Thou shalt know each others’ energizers and exhausters. What turns your partners on professionally? Do they like particular cases, patient types, and procedures, appraising new innovations, developing and marketing the business?  Conversely, what are the energy sappers? Despise hospital work but love to be in the office? Or vice versa? In this way you can better understand each other, and understand your partners’ motivations and some of their fears. From better understanding, the practice builds morale and trust.

Ninth Commandment. Thou shalt define reasonable and competent interpersonal behavior. For instance, what is a timely response to pages? To patient and staff requests? What should partners refrain from? Possibilities include sexual innuendoes and sexual harassment, abusive language, sarcasm, racial or ethnic slurs, and threats of violence, retribution or litigation. How should concerns about clinical judgments be expressed or offered? What about favoritism, or criticism? A clear definition of what you (the practice) consider acceptable behavior provides credibility (clinically and professionally) when/if you have to confront a partner about unprofessional behavior. It also prevents disruptive partners from exhausting their colleagues for years and years. Develop a definition of professionalism, especially as it relates to interpersonal behavior. Develop a policy to deal with transgressions.

Tenth Commandment. Thou shalt never use e-mail to communicate discord. E-mail is for concrete issues, like call schedules or finances, not for emotional issues where your words cannot be moderated by non-verbal communication and explanations. If you have an issue with a partner, set up a time to talk in private. Try to reduce his/her defensiveness by using phrases like, “I have a concern I’d like to share with you” or “Help me understand this rumor.” Be as clear as possible about the dates, times, and anecdotes. Proceed in as non-judgmental an attitude as possible – and listen carefully.

Follow these commandments, and harmony will pervade your practice so that really difficult things can be considered and not poorly processed.

John-Henry Pfifferling, PhD, Director

Center for Professional Well-Being

Durham, NC · 919-489-9167 · www.cpwb.org

Originally published as an interview in Group Practice Solutions, October 2001, Advisory Publications, pages 4-5. This text is slightly modified. www.AdvisoryPublications.com . © Advisory Publications, 2001