Is Your Office Like a Dysfunctional Family? What to Do

Shelly Reese


September 11, 2013

In This Article

What's Causing Your Office Dysfunction?

There are probably as many causes of dysfunction as there are employees, but in a healthcare setting, a few common culprits frequently crop up, experts say.

Silos That Prevent Cooperation

In many practices, people define themselves and their coworkers by their functions, Hertz says. "There is the physician and the NPs and PAs, the medical support staff, the billing staffers who sit in a little room and look at computer screens all day, and the front desk support staff. When we talk about an office, we talk about them as if they're in 25 different countries."

Because customer service depends on the coordinated efforts of all of these players, it inevitably suffers as a result of this fragmentation. Hertz cites an example of a urology practice where he discovered that the water fountain in the waiting area was broken. When he asked the receptionist about it, she said it had been out of order for about 3 months. "Has anybody been called to have it fixed?" he asked. She shrugged. "Nobody felt like it was their job to pick up the phone and make the call," he says, "and the doctors probably didn't even know it was broken."

Distrust That Creates Fake Harmony

"If you don't trust people, you can't engage in healthy conflict, so you create this artificial harmony," says Stratman. "Everyone pretends to get along until something happens or someone blows up."

Unspoken Rules That Prevent Communication

"In a dysfunctional organization, there are things you can do that will get you in trouble, and nobody will tell you what they are until you get in trouble," Bernstein says. "Directions are ambiguous and often vaguely threatening. If you complain, the problem is with you rather than what you're complaining about. You're expected to feel lucky that you have a job. Often in medical spaces there's a huge dividing line between physicians and everybody else: Physicians can do no wrong, and everyone else can get called on the carpet."

Lack of Managerial Skill

"Healthcare hasn't done a good job of training up managers," Stratman says. "If you're a good nurse and you've been around for a while, you become a nurse manager, but you don't have the tools in your toolbox to do the job." Alternatively, Bernstein says, people may be promoted through the ranks because they know how to work the system and spout a message that plays well with higher-ups. Hospital department heads "may be better at minding the budget than at being an advocate for the department."

Vague Expectations

Without clear expectations, you can't hold people accountable for their actions, Stratman says. "It's like telling a kid to clean up his room. Unless you make it clear what you expect, he's going to sort of make the bed and maybe pick up a sock. People rise to the occasion if you make the expectations and the consequences clear. Lack of clarity leads to inconsistent enforcement, and you don't have a leg to stand on if that happens."

Stress That Leads to Strained Relationships

The healthcare arena is a stressful place to work. Electronic medical records, increasing regulations, heavy patient loads: Stress contributes to dysfunction.


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