Addressing chronic conflict and problematic behaviors in a group practice

1. Background Analysis Targets In a subspecialty intensive care unit with 60 hospital staff members and a 5 person physician group, conflict between the physicians was compromising quality by disrupting the continuity of care, hindering communication and creating a tense work environment. Addressing chronic conflict and problematic behaviors in a group practice Current Condition Themes from preliminary interviews: • shift-work mentality (“you just do your work and go home”); collaborative interaction limited to sign-out rounds; doctors want more cohesiveness • perception of “immature” or “petty” behaviors on the part of others, dismissed by some as just “personality differences” • little awareness of negative impact on quality or the negative perceptions of the practice throughout the hospital • conflict-averse leader, no systematic accountability; doctors want stronger leadership • new practice director hired from outside, about to take over Implementation 360 feedback for individuals and practice based on interviews and RCS Individual feedback reports Practice retreat for teambuilding, skills development and dialog to create collective vision and expectations 1:1 meetings with director q 3 wks to develop and track individual performance goals Coaching for practice leader Relational Coordination survey scores: Results/Follow-up • One physician was unable to meet individual performance goals and left within 2 months. • Each of the other 4 physicians improved their individual RCS scores. • The practice began to meet weekly, created clinical pathways and started QI projects. • At a follow-up retreat 6 months after the first one the practice made plans to improve service to internal customers and practiced the necessary communication skills. • The RCS shows potential as a feedback tool and demonstrates sensitivity for tracking longitudinal changes in individual and group performance.