Michael Port, MD, medical director and anesthesiologist at DISC Sports & Spine Center in Marina del Rey, Calif., discusses eight ways ambulatory spine practices can manage conflicts successfully.
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1. Make sure everyone is invested in the spine practice. It's important for surgeons to feel invested in the spine practice's success, whether they have financial ties to the center or not. At DISC Sports & Spine, nearly all practitioners are financial investors and are interested in keeping the practice open.
"It does help when at the end of the day everyone is a partner in the same business because you understand everyone is doing this together," says Dr. Port. "If we have a big issue, we can get together at a partner meeting and discuss what works well and what doesn't. If something needs to be changed, we'll vet it at the partner meeting and discuss it."
2. Deal with conflicts at the micro level first. When a conflict arises, physicians should know where to turn. The practice administrator or medical director is a great place to begin the discussion, and then partners can resolve issues between each other in the larger, more formal board meetings if necessary.
"Informally we have a head nurse and chief operating officer who tries to coordinate different disciplines in the spine practice when an issue arises," says Dr. Port. "They will speak to the COO first with the issue, and if it's a problem with anesthesia or nursing she'll discuss it with me as a medical director. Some of the small issues become policy changes, but they always start with our COO."
3. Form a consensus on big issues at board meetings. Open up board meetings where big issues are discussed to all partners and participating surgeons. Even if it's just a small policy change, surgeons may want to have input. It's also helpful to have their presence so they understand any changes that occur.
4. Don't wait to address immediate issues. If something needs to change immediately, based on new regulations or other issues, don't wait for the quarterly board meeting to tell the surgeons. Instead, quickly notify them through digital media and tag the message as important.
"We had to make a change in our process to ensure patients were signing consent forms with the surgeon before they began anesthesia," says Dr. Port. "This was a legislative change, so we had to make it immediately and disseminate that information to surgeons. We couldn't wait to have a board meeting because we would have been in violation. The message was disseminated via email."
5. Perform due diligence on new partners. The best way to avoid a rocky relationship with practice partners is by bringing on physicians who won't cause problems. "If you can avoid difficult personalities, avoid them," says Dr. Port.
The healthcare culture often revolves around the surgeon, but bringing on someone who is used to being the sole decision-maker could lead to problems. "This may create lack of compromise," says Dr. Port.
6. Hire a strong human resources department. As a small business, your practice should have a human resources department, or outsource those services. "HR is a much more effective, safe and clean way to deal with conflicts," says Dr. Port. "It protects the organization to have established policies to deal with conflicts."
DISC Sports & Spine has a full-time human resources employee to handle issues between staff members quickly. "Don't let these things simmer," says Dr. Port. "Pull the parties aside and have an objective mediator to help them communicate freely in a constructive environment."
7. Involve partners and employees in decision-making. Bring in surgeons and employees when a big change is coming to hear their concerns, even if the change is unavoidable. They can help you structure a strategy for meeting new challenges that's more efficient for them.
"The best thing you can do is involve partners and employees in the decision, even if they can't change it," says Dr. Port. "Empower them in the decision. Educate them and explain what needs to be done and do it as soon as possible so they aren't hearing about the change later. Tell them why vacation time has to be cut or distributions are decreased so it makes sense."
The key is providing good, timely communication in a respectful way because a perceived lack of control will make people anxious.
8. Anticipate problems so you can avoid them. Whenever possible, anticipate the big issues you might have and make sure all physicians understand how to avoid them. If your practice includes an outpatient surgery center, all surgeons should be comfortable with appropriate patient selection for the ASC so you don't find out the day of surgery that the patient can't have their procedure done there.
"It's of the utmost importance that everyone is communicating," says Dr. Port. "If the nurse says a surgeon consistently brings in one type of patient and they have a hard time managing that type of patient safely, we have an issue. That will impact all of the partners. On the other hand, if nurses aren't educating patients properly or patients are in too much pain, that's a problem when they go home."
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