team conflict

When I first joined the executive team at my hospital as its VPMA (vice president for medical affairs), little did I know that conflict would become a welcome part of the job. One of the most challenging aspects was learning to contribute more openly in weekly strategic meetings. I had some exposure to strategic planning meetings as a hospital board member and on various committees in my state medical society.

But this was different. The CEO, COO, CFO and seven or eight VPs met weekly to discuss strategic initiatives and other challenging issues. I was intimidated by the fact that we would be making decisions that affected thousands of employees and patients, residents and clients.

So I was sometimes reluctant to jump into the conversation. The CEO was good about encouraging me to contribute during the meetings. Truthfully, I mostly listened carefully for the first year of meetings, adding little until I began to feel more comfortable with the process.

My reticence was in part due to my introverted nature. I was also a perfectionist and self-conscious about comments I thought might be seen as unwelcome or unhelpful.

It was not until several years later, after the CEO that hired me had moved on, that the new CEO led us through a concerted effort to improve our functioning as a team. We started by working on trust, as I previously discussed in Lack of Trust in the C-Suite. When we felt that trust had improved, the team moved to the second building block of effective teams described by Patrick Lencioni in Five Dysfunctions of a Team: Conflict.

Conflict is Essential in Executive Teams

turtleI could readily understand the need for trust in a team. We needed to work together, and have meaningful conversations.  We needed confidence in one another. But actively inviting conflict to our meetings seemed counter-intuitive.

I had tried  to avoid conflict most of my life. I wanted to please people. I did not want to confront and possibly aggravate them. As a physician, I was trained to de-escalate anger and frustration in patients, not promote it.

But we learned, by reading Lencioni's book and working with an executive coach, that we would need to embrace conflict within the team, in a non-threatening way, in order to fully dissect and address critical decisions.

As Lencioni states: “All great relationships, the ones that last over time, require productive conflict in order to grow.” Note the words “productive conflict”. This must be distinguished from “destructive fighting and interpersonal politics.”

I agree wholeheartedly. Based on the work that we did, our team was much more effective when we had a passionate discussion about a difficult issue. Should we consider proceeding with a major expansion in the face of difficult economic circumstances? Should we develop a new service line that would require significant financial and human resources for several years? I realized that avoiding conflict resulted in poor decisions and often only delayed the inevitable day of reckoning.

We learned that we should not shy away from tackling difficult questions. And, rather than attack a person or their position, we learned to be inquisitive. Because of the time working on trust, we knew we could be open and not be attacked or belittled by our colleagues. And there would be no politicking or back office deals made outside of the meetings.

Ask Probing Questions

During these fierce group conversations, I found that it was best to ask questions, rather than make statements. The point is not to have a debate, but to fully explore an idea using all of the available talents and perspectives of the team. It's important that during these discussions the CEO (or whoever is chairing the meeting) encourages full participation. He or she may need to allow seemingly difficult and uncomfortable confrontations to proceed, while assuring that personal attacks do not go unchallenged.

Let's consider a situation in which the team is deciding whether to open a clinic in a small town 15 minutes east of our town. To do so will mean leasing an office and hiring a new family physician to work there. The VP for Strategic Planning, COO and CEO all believe it is a pretty good opportunity, based on the fact that many of the patients living in that area now tend to utilize a hospital 30 minutes further east.

Poorly Facilitated Conflict

During team discussions, comments like these will not be helpful:

  • The last time we tried this, we lost a lot of money and alienated the local physicians.
  • We really don't have the funds to devote to a project like this.
  • We'll never be able to find a physician for that location.
  • This plan seems really poorly thought out.


Promoting Positive Conflict

Constructive comments that might be more helpful include questions like these:

  • Do we have any insight into the reaction of the local physicians and/or the community to opening this clinic?
  • What does the pro forma look like? What kind of ROI are you projecting? Can you show us the assumptions that went into that projection?
  • What does HR say about the ability to recruit a new physician to this site? Have you explored the possibility of moving one of our established physicians to the clinic to work there part-time to get things going?
  • Perhaps we could all take your presentation and review it in more detail. Then could we run through a SWOT analysis at our next meeting?


Final Thoughts

I cannot emphasize enough how fear of conflict can impede progress in becoming an effective team. Please let me know your thoughts in the comments.

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