Not only is the Practice Manager (PM) in a unique ‘managing-the-managers’ role with the partners of the practice, but he or she is also often solely responsible for managing the practice staff. The PM usually has no immediate peer group to call on for support or aid in the many daily decisions that must be made, and the authority of the role will tend to be isolating. Stress from this role may come from many quarters:

• Staff unhappy with change, staff unhappy with workload, holiday rotas or current schedules and ways of working.
• Personal difficulty with a particular staff member or staff members.
• Being the buffer state between the staff and the partners.
• Isolation

Staff unhappy with various aspects of their employment

PMs know about management. They know that good communication is essential, that a sense of ownership via involvement in decision-making makes for harmonious working relationships and that perceived even-handedness limits discontent. When unhappiness arises regardless, swift action is essential to curtail its potential spread.

Suggestion:

• An initial meeting with the staff member to discuss his or her concerns. The purpose of this meeting is to get to the bottom of the staff member’s issues. Consequently, your role will be predominantly that of the active listener and any questions or comments will be to elicit further information to build a clear picture of what is wrong, including any contributing factors.
• A further meeting with the staff member will then be needed after you have had time to consider the problem, make further investigations where necessary and looked at what is possible and what is not.
• You talk these things over with the staff member and see what level of agreement is possible to take things forward. If the level of agreement is very low, then focus on where you do agree and see if it is possible to build on that.

The situation may be very delicate and require incremental steps so that trust is not lost. It may require a change in your own way of working or some other form of innovation that you had never considered. Staying open to possibilities is vital, and flexibility on your part means that staff know they will not only be heard but that their views will be respected, valued and may form part of new approaches to working.

Personal difficulty with a particular staff member or staff members

One of the most important aspects of management is creating and maintaining a good, effective, harmonious working team. Despite time and energy devoted to creating positive working relationships, there may be individuals who are overtly or covertly unhappy with the status quo. When this is personal, action needs to be taken swiftly to curtail the spread of negativity and threat to team morale.

Suggestion:

The way to resolve personal conflict follows the same route as suggested above for staff who are generally unhappy with aspects of their employment. However, as this is personal rather than general, it is vital to be as honest as you are able about the part you may play in the difficulty. Responsibility for any relationship is shared equally, but where one person has authority over another, boundaries and clarity are essential.

• It may be useful to review the staff member’s job description with them and to see whether there is joint agreement about what it means in practice. If there is a different interpretation about role and responsibility, this may be at the basis of the problem.
• It may be that the staff member feels unfairly treated or discriminated against. If their evidence for this is fuzzy and based predominantly on their feelings rather than on something that was actually done, ask them to try and pin it down. If you are unable to remember incidents or events cited, be honest about this but assure the staff member that their feelings matter. If you can remember incidents and there is some truth in what the staff member says, it is important to explore this with them and be honest about your part in what took place.
• The most important step in taking things forward is for the staff member to be able to state what they want. This may be a change in conditions, workload, working relationships or any number of other things. The important thing is that they focus on the problem, name it and say what they would like to happen about it. You can then take some time to consider the problem, consider your own part in it and to decide what would be best for the staff member, for you and for the practice. You can then have a further meeting where you can talk this over.

You may also find the section on Emotional Intelligence in Professional Relationships useful.

Buffer State

You may be the PM in a practice where partners regularly meet the whole practice team. If so, there will be ample opportunity for staff to raise concerns. If not, then you may find yourself constantly fielding staff concerns with the partners and fielding partner concerns with the staff. Indeed, the partners may insist that a major part of your role is leaving them to get on with the job of treating the patients whilst you manage the non-medical staff. Whilst this may be reasonable in theory, it doesn’t generally make for good team morale in practice. Staff need to feel valued, respected and fairly treated, and if communication between them and the partners is always filtered via you, then they may well find it hard to believe in their own importance to the practice and you will be the main target for their discontent.

Suggestions:

Consider what opportunities for greater communication could be built into the working week:

• Coffee breaks, lunchtimes, half-day training sessions.
• Staff feedback sessions.
• Staff leading workshops for partners.
• Anonymous suggestion boxes.
• Staff news bulletins.
• Targets achieved noticeboards.
• Point of contact in the day set up.
• Birthdays celebrated.
• Cross practice initiatives and projects set up to encourage people from different sections working together.

Anything which diminishes an ‘us and them’ culture and works towards a positive team culture will pave the way for optimal communication and working relationships.