Confrontation ("Lets Talk")

By Diane McCutcheon, President


Confrontation – definition: 1. Encounter: a face to face meeting or encounter especially a challenging or hostile one; 2. Conflict between ideas or people – conflict between ideas, beliefs or opinions or between the people who hold them.

Everyday owners of private practices are challenged with having to confront someone or something – employees, referral sources, vendors, broken equipment and a number of other things that come up.  

Let’s look at some of the most stressful days an owner or manager faces.  It might be the day you have to give a performance review and there is no raise this year; or terminating an employee or worse - a family member who just isn’t working out; or moving to a new vendor and having to say goodbye to the one you have used for years and has become your friend; or maybe having to address the fact that your computer equipment or software is just not going to make it another day and you have no clue as to how to begin figuring out what you need, not to mention all the new “compliance” issues that you have to address.

We all have our own styles of confrontation; do you see yourself in anyone of these scenarios?

  • Vent to next in command and let them manage the situation   
  • Yell at the whole crew even though your words  are for one person
  • Ignore the slacker and hope that they resign
  • Discuss issues at meetings that are directly related to those in the meeting but not say so
  • Keep asking for things that you don’t even know are even possible
  • Email or text instead of confronting and talking with someone in person
  • Let everyone know that you want things done by the book but no one, including you, has that book
  • Give control to someone to make important decisions (i.e. purchasing software) not really knowing if they are capable of handling it but still blaming them later.

If none of these scenarios apply to you – good for you – it would seem that confrontation is not a big problem for you.  For those of you who do see yourself in any of the above situations, note this: you may have poor communication skills and you typically agonize the most about confronting a person or issue when you have let the situation get out of control.  Here are a few suggestions that may help you:

Implement standards for everyone in the business – starting with and including yourself.  For every responsibility listed on a job description you should have a standard of what is acceptable and what is not. You can also set standards for things that occur on a recurring schedule.  These are things that are to be done daily, weekly or yearly i.e. safety checks, annual equipment maintenance, etc.  If it is not done, someone is letting you down. 

Let’s take a look at one function of a Front Desk Specialist: 

  • Responsibility:  process new patients  
  • Get all patient information on the phone and check benefits before the patient arrives 
  • Standard:  New patient benefits will be checked the day the intake occurs 
  • Situation:  You find out that patient benefits are not being checked daily and in many cases are not checked before the patient comes in to your clinic  
  • Who is responsible: Janie, the front office specialist who works full time days  
  • When to handle:  As soon as you become aware

In a case like this, it is easy to confront the person because you can relate the noted deficiency to your practice standard.  “Janie, please make sure that new patient benefits are checked the day you take their information – that is our standard procedure.   However, this has not been occurring, is there a problem we should discuss?  If this is an ongoing issue, you might approach the discussion in this way, “Janie, we have discussed this on several occasions and we agreed you would improve.  Perhaps it is time we consider whether or not this is the right job for you.” 

Let’s look at a manager responsibility:

  • Responsibility:  Prepare weekly clinic stats:  Patients seen, cancels, no shows, new patients, % of arrival, % of co-pays collected at front desk
  • Standard:  All stats must be reconciled and on the owner’s desk by 9AM every Monday
  • Situation:  You are not getting the stats until Thursday or Friday and this week you did not get them at all
  • Who is responsible:  Assigned manager
  • When to handle: This should have been addressed the first day the stats were late

In this case – as soon as the stats were not available on Monday at 9AM, a call or email should have been placed to the manager asking why they were not received.  “I didn’t receive your clinic’s stats this morning – when can I expect them and is everything okay?”  You need to evaluate the excuse you will get – you are the boss what can be more important than getting that information to you on time?  For example, if the biller, who gets the stats for you was out of the office, there is a problem – what’s the backup plan should the biller be gone?  This is the manager’s responsibility.  You need to evaluate the manager’s ability to manage their time and resources and address deficits in these skills.

Setting standards and holding everyone accountable to the standards you have set makes it easier to confront those who are not meeting your expectation.  The challenge is making sure you have competent help in setting those standards.  For example, when your manager, front desk or billing staff say “we need more help” but  you are unsure if they do or not.  How can you evaluate that question if you do not have standards to measure the productivity or value to your business?  What will be your return on investment if you hire a new person?   Who can you trust to help you make that decision?

Whether the employee is a family member or not, being able to look at the entire scope of their responsibilities and measure that against standards that others have been able to meet gives you the confidence and knowledge you need to address that person.  Addressing situations like this is noticed by others and helps to improve your credibility with staff.  They respect your making tough decisions based on facts.  This also helps to avoid a wrongful termination.    Morale and productivity is always down when the boss allows a poor performer, no matter who they are, to stay on because they don’t want to confront them. 

Putting off talking to business associates is another way of procrastinating – hoping they will go away before you have to tell them to go away.  As soon as you recognize service from a vendor is down call them.  Let them know what your expectations are and if they are not met you will have to leave them.  Even if your vendor is a friend, you need to communicate when things change and you or your practice need to make a change.  There is always a reason to move on – tell them honestly and hopefully you can still maintain the personal relationship – regardless, move on. 

Confrontation of any kind is not easy – but it is easier when you are prepared. Tackle things as soon as they begin.  Don’t lash out at a group when the problem is with one person.    Before you confront someone, investigate the situation and know the facts.  The consequences of keeping someone because you are afraid of being short-staffed are generally far worse than terminating an employee that is not adding to your team.

Diane McCutcheon, President
​DM Business Management Consulting Services, Inc.
Account Matters – Billing & Collection Services
4 Charlesview Road, Suite 4
Hopedale, MA 01747
P: 508-422-0231  F:  508-422-0234