Resolving Practice Management Conflicts Raises Many Questions

I hate conflict. And I am not very good at resolving it since my primary coping skill is avoidance. However, there are certainly many opportunities for conflict in the clinic setting. When we began to formulate this issue, I was reminded of some particularly troublesome examples ranging from the humorous to the shocking. I recall the frustration of the nursing staff when a physician slowed the clinic operations by applying Unna’s boots by herself so as to take advantage of the additional revenue. Situations such as these raise the question when some procedures can be billed by either the physician or the clinic staff, who ought to execute the procedure? My clinic has never had much of a marketing budget. However, once during a downturn in patient volume, a young administrator told me that since clinic revenue was down surely I should not spend my marketing money. I recall wondering what exactly it was that one learned in business school.

But just how does one market a wound care center? Do any of us know what really works anyway?

I also remember an encounter between a wound center nurse-manager and chronically late physician when he sauntered into the clinic an hour late with an Egg McMuffin in hand. Irate patients filled the exam rooms. The nurse asked him politely if, in the future, he could let her know when he would be delayed, and he called her a nasty name in front of the entire staff. As professionals it is expected that we will act appropriately towards one another and with consideration towards our patients. Unfortunately, this does not always occur.

How should such situations be handled?
Wound centers are remarkable operations. They function at the intersection of in-patient and outpatient services, require the smooth coordination of hospital staff and perhaps numerous physicians, require the cooperation of services as diverse as housekeeping and pharmacy, and necessitate employing high-quality staff from broad backgrounds. At my facility we might have former commercial divers (hyperbaric technicians), massage therapists (MLD therapists), and ICU nurses all working together to provide patient care. Each member of the staff must respect the role their colleagues play and these roles must be clearly defined.

How can one build a team like that?
For more than eight years I have practiced with a wonderful physician whose personality style is the opposite of mine. We are the perfect, ‘good cop, bad cop’ routine. When manipulative patients need a firm no, the nurses know to put her, not me, in the room. However, if bomb defusing is required, the nurses know to come for me. This means that our nurses are making a pre-emptive strike on potential conflict with patients. There is nothing more valuable than a nurse who can triage potential patient conflicts and keep the doctor out of trouble.
How do you find staff like that and keep them?
Many patients have very unrealistic expectations. How do we give them encouragement while creating realistic goals for their care? These are not issues, which you will find addressed in any other sort of publication. We hope this issue will provide some guidance in the practical art of running a wound center.

Caroline E. Fife, MD, FAAFP, CWS
Chief Medical Officer, Intellicure, Inc. | cfife@intellicure.com