Leadership In Practice

February 9, 2019 | Featured Articles

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As management consultants, clients reach out to us to help them identify practice management issues and make recommendations for improvements.

What we often find during our assessments is that the challenges have less to do with practice management shortcomings or best practices. Instead, we see that the underlying issues plaguing many practices are lack of trust, commitment, and accountability among partners (e.g., leadership team). Unresolved conflict and inattention to results are also problems we encounter.

All this leads to confusion, frustration, resentment and in the worst of cases, contempt at the highest level. Politics hinders progress, and even the most well-intentioned team members will lean towards unproductive behavior.

The consequences of unhealthy leadership teams are detrimental to a practice. However, a healthy, cohesive, aligned team not only attain the results it sets out to achieve but also get more done in less time with less the cost.

Fortunately, there are simple, yet effective disciplines teams can adopt to overcome the underlying hurdles hindering many practices’ ability to succeed in their best practices endeavors.


Trust is the foundation of a successful partnership. There is no substitute for trust. If partners don’t trust each other, then there is no point in moving forward.

Fundamentally members of great teams trust one another on an emotional level. They are comfortable being vulnerable with each other about their weaknesses, and mistakes.

Trust may seem like touchy-feely stuff. However, think for a moment on the potential outcome when trust is absent. For example, imagine a partner meeting where everyone approaches the meeting like a game of poker – everyone playing close to the chest – versus a genuine, vulnerable, humble pursuit to find the best solution to a problem.


Despite an abundance of unresolved conflict, many physician groups we work with are cautious—even unwilling—to engage in debate for fear of creating conflict or ambivalence.

However, avoiding serious disagreements is not only counterproductive, but it negatively impacts a team’s long term performance. Passionate, unfiltered discussion around important issues, on the other hand, is a healthy discipline. Moreover, lively discussions provide fertile ground for teams to push one another to make the best decision for the practice.

It is important to mention that for passionate debates to be productive, all partners must agree on the rules of engagement. Depending on your practice’s culture, the rules and norms can vary drastically. However, defining what is acceptable, and what behavior the team will not tolerate goes a long way in avoiding destructive conflict regardless of practice culture.


By far, the thing that most often prevents practices from making meaningful progress is the unwavering quest of obtaining one of the most elusive commodities in pediatric practices, consensus. Progress is stalled – often indefinitely – when the group fails to achieve general agreement around critical issues.

Paul Vanchiere, the founder of the Pediatric Management Institute, makes several insightful points in his book Managing the Mirrors. Vanchiere highlights that commitment is not consensus; commitment is about buying into a decision. He stresses that waiting for everyone on a partnership team to agree intellectually on a decision is unproductive.

High functioning teams can achieve genuine buy-in (i.e., unwavering support) around crucial decisions. Even when groups initially disagree about a decision, by engaging in productive conflict, they can eventually agree to a single course of action.


Imagine for a moment you are playing on a professional sports team. During practice, the team decided that Jenkins is in charge of guarding number 33 and Jenkins agrees to carry out the task. During the game, however, Jenkins does not follow through with the decision or his commitment to it. Number 33 scores multiple times and wins the game for his team. Would you hold Jenkins accountable or would you and the team let it slide? I suspect that Jenkins would be held accountable.

In the medical practice world (especially at the partnership level), the opposite occurs. Team members fail to confront one another around behaviors, deliverables, and agreed decisions.

The most critical test for building a team where people hold each other accountable is overcoming the natural human tendency to hold back on giving one another feedback. Withholding feedback hurts the partners and the team as a whole.

For teamwork to work correctly, the team must become comfortable with confronting one another’s actions that do not comply with previously agreed upon decision.


Results-oriented organizations establish measurements for their success. It is not enough to have trust, healthy debate, and commitment to decisions if the team doesn’t focus on results. Patrick Lencioni once said, “The true measure of a great team is that it accomplishes the results it sets out to achieve.” Simply put, the ultimate measure of a great team is results. Unfortunately, many fail at this discipline.

The key to avoiding inattention to outcomes lies in keeping results at the forefront of people’s mind. A simple, yet effective way to keep people focused is to use a visible scoreboard of some kind. The scoreboard is a simple way to track what it is your team wants to achieve, and how best to measure success. Just like in sports, workplace scoreboards eliminate ambiguity and subjective interpretation of results.

The negative consequences of unhealthy, dysfunctional leadership teams lead to low morale, confusion, frustration, resentment, and contempt. Not to mention the negative impact all that tension will have on employees, which will inevitably result in apathy.

These Five disciplines are difficult to put into effect. The good news, however, is that it does not require a superior intellect to ensure success. It does require courage, commitment, and consistency.

If tensions and unresolved conflicts are negatively affecting your team, the time to fix it is now. By establishing trust, embracing healthy debate, and committing to accountability and measured results, your partner relationships and your practice as a whole will be well on the road to success.