The Bad Partner – Why Intentional Culture is so Important

Episode #27: The Bad Partner – Why Intentional Culture is so Important

Managing poor physician behavior…I can almost hear you shudder.

We see many groups tolerating inappropriate, risky and even outright illegal behavior from physicians, especially those who are partners in their groups. It’s almost as if they can act with impunity, as no one sees it as their responsibility to coach, counsel or discipline a physician. And groups will rarely terminate a physician, even those with the most egregious behaviors.

We’ve seen groups with physicians who are:

• Inappropriate with staff
• Taking money from the practice in disproportionate shares
• Using prescription drugs or street drugs like cocaine,
• Unsafe with patients and practicing poor quality medicine

This sets up a great deal of stress and discomfort, especially if the physician in question is a partner in the business.

So, why don’t we deal with this?

Most physicians–and many administrators too–are naturally conflict avoidant – we went into healthcare to help others, not because we enjoy managing unruly people. So, we turn a blind eye.

We KNOW it will be an unpleasant conversation, and we’re worried about damage to the group’s reputation if the physician gets angry or confrontational when they are approached. We worry that exiting a partner will be difficult, conflict ridden and expensive, and we’re not even sure where to start. Then we start perseverating about possible lawsuits. Then we stop. We’ll deal with it the NEXT time an issue comes up.

The result of all of this is that poorly behaving partners SEEM untouchable. In reality, they’re NOT. And, keep I mind, they’re creating risk—and potential expense—for your group every day.

Remember, as we said in episode 23, you’ll get the behavior you tolerate – this is true for staff and physicians alike. 

And, physicians, like staff, deserve feedback and coaching when their behavior isn’t in alignment with the rest of the group. So, this begs the question, what does the group see as their culture?

Having intentionality around your culture doesn’t ensure that you’ll never have problems with physicians or staff, but it does ensure that you’ll have a clear path, and a good compass with which to navigate. In our last episode about recruiting, we discussed this – it’s imperative that you are intentional and mindful about your culture. If you’re not, it will evolve, and will generally follow the whims of the loudest partner or employee, who in many cases is the resident bully, and is only speaking his or her reality, not one that is representative of the whole group.

Developing intentionality around your culture takes time and energy, and is worth every minute! Begin by discussing it informally among the leadership and garnering support for taking it on. Once that’s established, continue by adding it as a discussion point to the agenda for your next Board meeting. Start slow…Rome wasn’t built in a day. There are many excellent guides available – one of our favorites is from Gallup, who’s research shows that only 2 in 10 employees feel connected to their organization’s culture. And while our numbers may be a bit higher in healthcare, there is clearly still work to be done.

Once you’ve socialized the conversation around culture, you’re on your way to being intentional about it. Many groups go on to develop Physician Compacts, which clearly delineate the “give” and the “get” so physicians are clear coming into the organization what they are expected to “give” the group—their time, their expertise, their commitment to practice under specified standards of care—and what they will “get” in return—compensation, benefits, and fair treatment. A note, Physician Compacts are separate and apart from Physician Contracts, which is a legal construct for employment or partnership, and we’ll have more on both in an upcoming episode.

As you continue with culture development as a standing agenda item for your Board Meetings, you’ll begin to develop some common themes. You might use those to create an informal list of cultural norms for your group, or you might spin it up into a formal Physician Compact. These can be powerful recruitment tools too. It shows that your group is mindful and intentional about its culture and how you will be with one another. We always recommend that your list begin with a cultural norm that you always communicate respectfully with your partners and colleagues. Everyone will agree with this statement when it’s made. And, not all of them will live up to it. 

So, when one of the physicians in the group behaves in a disrespectful way, it’s time to address it. This should be handled as soon as it starts becoming noticeable to partners and employees, and preferably BEFORE the first formal complaint. Given the #metoo movement and the general “woke” nature of our society today, poor behavior isn’t being tolerated, and is being called out, so there isn’t any hiding behind the profession as some physicians used to be able to do back in the day.

It is critical to have these conversations in private, typically 1:1 to being with, and we recommend that you take informal notes. If the behavior doesn’t change for the better, you can move to a 2:1 meeting to include your executive dyad partner or another physician partner as you get further into the discussions. Adding a second person to the conversation sends a message that the organization is taking the behavior seriously, and that the issue is not going to be swept under the rug. It lends more weight to the conversation. We will cover the Coaching – Counseling – Disciplining – Terminating continuum in an upcoming episode, so you’ll get the structure for managing behaviors that are outside of the group’s cultural norms.

As we said at the top of the episode, this doesn’t happen often, and your partner may have a variety of reactions. On the one hand, he or she may be hurt or embarrassed. You can manage this by pointing to the cultural norms you’ve developed, and underscoring the importance of all partners being in alignment around those. There isn’t likely to be much argument if you’ve laid that cultural groundwork. Another possible reaction is that your partner will be angry or a bit hostile. This happens when people are stuck in a right/wrong paradigm and they feel as though you’re telling them they are “wrong” when in reality, what you’re telling them is that their behavior doesn’t fit with the group norms. They may or may not be able to understand the distinction, and in the end, they may or may not be able to be successful as a member of your group. And while that may sound harsh, so is subjecting the rest of the group to someone who doesn’t honor the established culture.

We want to engage in these conversations, uncomfortable though they may be, so that we are actively managing and mitigating risk and keeping esprit d’corps high! In this job market, staff will not tolerate a poorly behaved physician or boss and they’ll go to work for another clinic if they see poor behavior being tolerated. Same for patients, and if the behavior is egregious enough, you could see referral sources drying up, and the practice as a whole could suffer reputational damage and could begin to atrophy. So, step into the leadership role, and do the “hard thing” of holding everyone accountable to the culture you’ve created together. You’ll reap the benefits for years to come!

Join me for our next episode, where we’ll talk about Physician Contracts, why they’re important, and what they should include.