Powerful partnershipsBMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7158.2 (Published 29 August 1998) Cite this as: BMJ 1998;317:S2-7158
Merry Graham and Judy Carney outline the approach of their consultancy, which facilitates sessions in practices with strained relationships
- Merry Graham, management consultant,
- Judy Carney, management consultant
Our work is based on the belief that every partnership has the potential to be extremely powerful. Maximising this potency comes primarily through knowing each other's values and goals, how you work best, how you learn best, your strengths and key skills, and those situations or behaviours that cause the greatest pressure. In learning about ourselves, we open ourselves to learning about others, creating an environment of openness, curiosity, understanding, and warmth. Partnership is a word used so often that it is easy to lose a sense of what it means - a joint business venture between two or more people. The modern partnership needs an infrastructure that is flexible enough to adapt to the perpetual change of the modern business environment, and to fulfil the ambitions of the individuals within it.
Quick self audit
These are exercises you can do to clarify what matters to you:
Make a list of the values that you aspire to
Think about how you would finish the following statements:
I want to spend more time….
I want to spend less time….
Who trusts me and why?
Who are the four people in this organisation most vital to my success?
What could I do to make them feel more valued? Where do I feel valued?
What good quality in myself do I most overlook?
What good quality in others do I most overlook?
Strain in partnerships
When partnerships get strained, what is happening? People feel too overloaded to be able to look for solutions, and issues that were previously unresolved have come to boiling point. Partnership between general practitioners can be even more pressurised than other business partnerships if all-knowing doctors, superhuman in their ability to deal with suffering, carry that attitude into the management of their practice.
Our approach is based on research we conducted among 35 London practices to determine their model of a successful partnership. We found that money, time off, recruiting staff, and different management styles were the key areas of difficulty.
The practices said that the most important elements in resolving disagreements were dealing with conflict within 48 hours, a weekly meeting that focused purely on improving standards, having fun time together, and excellent processes to recruit good support staff.
The first step is to begin the process of identifying clearly the needs of the partnership. A simple way of doing this is to ask: “What is it we as a partnership want to stop doing? What is it that we will start doing instead? And how will we know that we have achieved what we set out to do?” The nature of general practice means that the answers must be things that can be done without extra money or time. One practice finds its common goals by keeping a solutions book in the main office headed “I wish I could find a way to…” All members of the practice write down a problem to which they would like a solution - for example, “I wish I could find a way to hear more positive suggestions from everyone in meetings.” Everyone contributes two solutions and these are shared in a monthly solution seeking meeting.
Another practice asked for our help with two staff who alternated between yelling at one another in front of the patients and frostily ignoring one another. The whole team got together for three lunchtime sessions to build a team protocol for resolving disagreements, and a “behaviour charter” is now pinned on every office wall.
A whole team approach was necessary as the partners were being dragged into behind-doors chats with the protagonists, which was in turn putting the partnership under stress.
Looking closely at some of the many ways we have of defining ourselves at work may offer some insights. Some of the instruments used are outlined in the summary boxes. Different people can have very different styles, which are not always immediately complementary. Although partners are often chosen to balance the skills in a practice, when the partnership comes under strain the skill that was valued as a difference can be labelled as a difficulty. Knowing your profile is of no use unless you choose to use it as a tool to improve communication.
The Belbin profiles(1) can be used to spark discussion on how to get the best out of one another and anticipate possible future misunderstandings, and they can be incorporated into a development contract to be used at subsequent appraisals.
There is a wealth of self perception exercises designed to give clarity on how different personalities will react in a variety of situations. Doing these exercises allows an examination of our beliefs about ourselves, our identity, our skills, our behaviour, our boundaries, as well as our beliefs about others, which provides an opportunity to review them. Do they empower you or limit you?
With this understanding goals can be set, roles defined, and procedures and relationships refined with insight and compassion.
The first question when setting goals for a partnership is, “What do we want to achieve?” These goals should be prioritised as urgent (the next 6 months), short term (1-2 years), and medium term (5 years). The specific extra skills needed to get to those goals should then be identified, as should the difficulties that might be anticipated if these expectations are not met.
Roles are functions that need to be performed in order to achieve your goals. Once again, it is in answering a few relevant questions that your areas of strength and contentment emerge. Does the role I am currently in suit me? Do I feel that the role plays to my strengths?
A London practice used this process to resolve a permanent competition about who worked hardest, and decided to adjust their roles for a three month trial. This helped all four partners to see where their personal role fit was creating extra pressure, and it helped them to stop bickering and start working towards a common goal.
Conflict is inevitable, so having procedures to resolve it is vital. The partnership needs to look at the behaviours that individuals bring to the conflict and at how they react to the behaviour or the personality of others. Reframing this understanding - for example, changing a perception that a person is arrogant to an understanding that the person is very organised and behaves arrogantly when stressed - helps the team to stay focused on how to use the person's strengths. Inviting each individual to consider what they do that might create blocks or conflicts, and asking them to find a set number of solutions to resolve this, is a constructive exercise and is something that all practices should do regularly. Holding meetings
There are three main types of partnership meetings: for sharing concerns, problem solving, and reviewing activities. The guidelines for effective meetings are to make sure that you focus on just one of the three types of meeting at a time and have one clear objective for the meeting. Be clear about the strengths you and your colleagues bring to the meeting. If someone is great at detail ask them to review the points before the meeting and ask them to present only the top four issues in a maximum of five minutes. Finish the item by reviewing a checklist of points to be covered before moving forward to a decision. Be sensitive to the differing learning styles of the team.
Activists: Enjoy new experiences, are enthusiastic about new ideas, thrive on challenge, and are open minded
Pragmatists: Search out new ideas, enjoy making practical decisions, see problems as a challenge, and are practical and down to earth
Theorists: Tend to be analytical and objective, think problems through in a logical manner, feel uncomfortable with subjective judgments
Reflectors: Like to stand back and ponder on experiences, are cautious, keep a low profile and collect data, and consider carefully before making a decision
Always end by reviewing the meeting, covering what worked well and what could be done differently next time. One Scottish practice we worked with began to divide its meetings into four parts: “Opportunities for growth,” “What would we do differently,” “My personal moan,” and “What have we excelled at.”
Relationships with staff
Building self awareness is the key to success in relationships: being clear who you are and understanding the unique strengths that you and others bring. This, in turn, facilitates rich, rewarding communication and allows us to learn empathetic listening - not offering advice, not putting our point of view, just listening.
Setting up a written protocol which states how mistakes, rewards, feedback, and teamwork are handled is a useful way of maintaining the quality of relationships. Mistakes are converted into learning experiences by involving the person who made the mistake into the resolution of the situation; staff are also asked to design team training courses, and these are supplemented by frequent feedback.
Many practices have found that mentoring(2) for partners and the practice manager is an effective way of keeping emotions in their rightful place: one hour per month is often all that is needed to keep clarity.
If perhaps we feel that the differences in values and goals with our colleagues are too great, it is to ourselves that we look first to check whether it is us that is creating the difference, or us that is compromising our values. It is this checking in, not just with goals and values but with needs and wants too, that facilitates clear communication and empathy with all the benefits that that brings.
Listen to your language: is it forward thinking, building energy and trust (“Let's find a way”), or negative and draining (“It's not possible”)? The longest journey begins with a single step. Steps can be planned, the journey broken up into achievable chunks; and the journey itself can be enriching, rewarding, and illuminating.
When you have several of the foundations in place for a successful partnership, keep it in tip top condition with regular meetings to look at the successful areas and explore how to apply this to areas that you would like to improve.
Then go out and share your skills with other practices: those who teach, master.