Professional Interactions – Best Practices Series
Identifying, Discussing & Resolving Issues
By Fred Corbus
This article first appeared in Round-up Magazine, official publication of the Maricopa County Medical Society.
This continuing series of articles is focused on providing an understanding of the value and role or 'processes' (tools and methods) for the improvement of professional interactions. In some cases, this means the development of Shared Values or a Code of Conduct (Round-up, July 2003 issue) or improvement in the way meetings are held (Round-up, November 2003 issue). Although many times meetings such as these do resolve underlying issues, I tend to think of these subjects as proactive in nature: because they provide an opportunity for enhancing professional interactions.
Sometimes, however, the vitality of the practice itself is being threatened because of serious, obvious, or not so obvious issues. It took me years to answer the question 'How in the world do I identify the real set of issues, get everyone to talk about them, and then efficiently move on toward resolution?' My answer:
- Interview all relevant parties (while drafting detailed interview notes).
- Design a succinct set of hard-hitting, east-to-answer questions.
- Distribute the questionnaire with a request that everyone fill it out, keep his or her answers confidential, and bring the questionnaire to the special meeting.
- At the meeting, go around the table and record everyone’s answer on a prepared flip chart (anyone who didn’t fill out the questionnaire or forgot to bring it is called first for his or her answers). When answers for each question have been tallied, each person is then given the opportunity to explain his or her answers and question other people’s points of view (this quickly puts you on the road to resolution).
My label for this process/tool/method is simply 'DISCUSSION QUESTIONS.' Four prerequisites are needed for success:
- The interviewer must be respected and seen as impartial and he or she must be well versed in the principles of interviewing and be able to take detailed and confidential interview notes.
- Most, if not all, of the people involved in the issue have to be interviewed in order for the real issues to be identified and a hard-hitting questionnaire to be designed.
- A simple universal agenda with two or three generic questions must be given to each interviewee.
For example:
- From your point of view, what are the causes for…?' (state the presumed overall issue).
- As you see it (Fill in the blank).
- What are your best suggestions for improving the situation?
- As already alluded to, the questionnaire must be a result of a careful analysis of detailed interview notes, to the point, and extremely easy to fill out.
This process has proven so extremely successful that I want to more clearly illustrate its potential by providing a few noteworthy examples.
CASE STUDY #1
Approximately four years ago, one of my clients informed me that the group was considering joining another group of the same specialty. There were many personal, professional, and competitive reasons for this merger, but there were also questions regarding different physician cultures. These docs all knew each other well enough to know that these differences needed to be addressed. I held a confidential interview with each one, and after carefully reviewing my interview notes, designed two sets of Discussion Questions. Each set of questions included an introductory sentence, followed by 8 – 10 questions. Below are one of the opening sentences and five of the questions.
1. 'After interviewing each of you, I feel that issues fall into several areas; however, the seriousness of these issues varies from physician to physician. Indicate how serious each of the following topics might be.'
Case Study #2
My second example regards a small to medium sized hospital-based specialty practice that had undergone a relentless series of very stressful events over a 3 – 4 year period: turnover of physicians (for totally 'legitimate' reasons), addition of new doctors, eroding support from the hospital, a significant increase in the patient census, two physicians who, although clinically very experienced and competent, did not fit the practice persona, and a very demanding and unyielding call schedule. Clearly, everyone had to 'step back' and talk about what was going on. After analyzing my interview notes I identified between 6 and 11 questions for each of four topic headings: Overall Practice Climate and Physician Behavior, Internal Communication and Governance, Quality of Patient Care, and Internal Issues. Below is a list of the questions I developed for the first topic (Questions #1 – 11) and the third topic (Questions #20 – 25).
1. Please evaluate each of the following items on a scale of 1 – 10: a 1 being ‘worst possible/of terrible concern,’ a 5 being ‘barely acceptable,’ and a 10 being ‘best possible/of no concern.'
Case Study #3
My third example represents the classic situation of two practices in the same specialty serving different geographic areas. The practices that know each other well but can’t seem to figure out if they should or should not join forces. It was the typical story of medical directors, members of a board, or the executive committee getting together over dinner two or three times a year to talk about the idea in the face of overwhelming ambiguity. After a few years of doing this, my client called, I interviewed all MDs from each practice, and I then put together 18 questions based on their concerns expressed during my interviews. Below are two of the questions.
2. 'Please indicate how much of an advantage you think each of the following subjects would be if the two groups ‘merged.’'
In each of the three situations outlined in the case studies, all participants provided input, actively engaged in the follow-up discussion, and contributed to the development of specific, practice action plans aimed at correcting the situation.
If you should have any questions about this process, or anything in this article, please feel free to give me a call.
The development of documents such as these is an investment of time, requiring meetings where participants listen and understand. Gaining a joyful environment within which to practice medicine makes it all worthwhile!
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