A busy practice is wondering why it is struggling to recruit more doctors.

The team is lovely, ‘we all get on really well, never a cross word’.  The practice manager agrees, ‘the partners are just really nice’.

The problem is they’ve been trying to get their document management workflow right for years but no-one’s on the same page. The doctors are staying later and later just to get everything done and even though they’ve been offered half a clinical pharmacist by the PCN they’re a bit unsure about how it will work for them.  When they tried it before, the person they appointed moved on after three months.

In this day and age, being ‘nice’ just won’t cut it for your team.

You see the problem I’ve seen the most in practices is not out and out war between the partners (though that definitely exists!) but the problem of people being too nice and a fear of conflict, which produces artificial harmony.

We all know that destructive conflict can cause untold damage to teams and organisations and is to be avoided at all costs.  However we are in danger of throwing the baby out with the bathwater when we are so frightened of destructive conflict that we avoid having any constructive conflict that will help us to debate and solve problems and ultimately work better together.

If we avoid conflict, what happens? People ignore changes that are being implemented, don’t use the new systems and processes designed to improve things and carry on with business as usual. Bad behaviour is not addressed, groupthink happens and often the loudest and most senior (though it doesn’t always have to be) voice in the room gets their way.

‘For good ideas and true innovation, you need human interaction, conflict, argument, debate.’ Margaret Heffernan

How many ideas have been lost, initiatives gone untried, and changes failed because we didn’t have the constructive debates and disagreements needed to come up with better solutions?

With artificial harmony it’s not that people don’t disagree, it’s that they disagree and just don’t tell you. Then, if a decision is made that they disagree with, they simply won’t commit to doing it. (Think about how many times something was discussed and ‘agreed’ in a partnership meeting that people just don’t do).

So this fear of conflict leads to a lack of commitment – the second and third dysfunctions of a team as described in Lencioni’s ‘5 Dysfunctions of a Team’. This in turn leads to avoidance of accountability and inattention to results which will affect workload, performance and even patient outcomes.

So how exactly do we increase the amount of constructive conflict in our practices?

You need to start with building vulnerability-based trust. This is where you can trust that if you disagree over something, the relationship will still be OK. Trust that you can fail, do something wrong or just have a bad day and you’ll be forgiven. In short, it needs to be SAFE to speak up and to disagree. This is the basis of psychological safety.

Here are some suggestions about how you can increase the constructive conflict in your practice:

• Mine for conflict. In every meeting, in every discussion, ask every person to tell you 3 reasons why what has been suggested won’t work, or 3 potential problems / barriers or challenges they can see. Constantly ask people ‘what am I missing here? What are the downsides to this?’
• Assign different roles in a meeting – make one person ‘Devil’s Advocate’ (to disagree about everything!). Make one person the ‘Unconditional Supporter’ (to agree), and one person ‘Switzerland’ (to be completely neutral). Make sure you swap these roles around regularly so that one person doesn’t get stuck as the Devil’s Advocate all the time!
• Listen and ask questions. Give people ‘permission’ to disagree. Thank people for their contributions
• Build up trust within your team. Get to know people, have coffee together, understand where they’re coming from. Model vulnerability; admit when you’ve failed and when you’re having a bad day.

So next time you’re feeling frustrated and stuck, ask yourself, are we being ‘too nice’ here? How can we help everyone feel able to get their ideas and opinions on the table? You might just get a pleasant surprise.

Dr Rachel Morris, April, 2021

Further resources:

• ‘How Safe Do You Feel At Work?’ You Are Not A Frog podcast on Psychological Safety at work
• ‘How to Manage Conflict during COVID’ You Are Not A Frog podcast
• The 5 Dysfunctions of a Team by Patrick Lencioni

Want to learn more about how to increase trust and psychological safety within your team? Would you like to get a happy, thriving team at work without burning out yourself? Join Rachel in the Resilient Team Academy – a membership for busy leaders providing monthly Deep Dive Masterclasses, ‘done for you’ team resilience building activities, teaching you how to use the Shapes Toolkit coaching and productivity tools with your teams and giving you a likeminded community of peers. PLUS gain exclusive access to Ben and Rachel’s very special bonus course ‘How to work together across practices and networks: 6 mistakes leaders in healthcare make and how to avoid them’. This very special offer for Ockham Healthcare ends on the 2^nd May – click here for more information.