One of the essential elements of the successful management of a medium to large GP practice is the establishment and operation of an effective decision making forum, whose decisions can be clearly and confidently relayed to the Practice Manager for implementation. The ideals, philosophies, practices and approaches of each individual partner and the interactions and dynamics between them will all combine to influence the process of decision making and it is therefore vital that the partners of a GP practice should evaluate the effectiveness of their meetings. The identification and eradication of any issues that adversely impact upon efficient, progressive and dynamic management is the key to improving the effectiveness of partners’ meetings and, in turn, the management of the practice. The need for effective decision-making is, furthermore, now an imperative in the light of the perils that GP practices presently face.
In this review, we will examine some of those matters that are likely to have a negative effect on the efficient conduct of partners’ meetings and go on to demonstrate how those issues might best be resolved through the introduction of a particular approach, which has the specific objective of improving the way in which the partners manage their practice.
Differences Between Partners
Diversity, within a group of partners should be a positive contributor to any practice. However, within the context of a decision-making forum it carries certain dangers. Where partners are of different ages, cultures and backgrounds and possess different aims, aspirations and philosophies it is likely that they will hold a wide variety of divergent opinions. It is also likely, in larger partnerships, that the partners will not all share sympathetic personalities and character traits. These factors, unless handled sensitively, can result in a discordant atmosphere in meetings which will often be marked by:
- Uncertainty, anxiety, scepticism and apprehension
- Divided assessments, views, arguments and conclusions
- Continual reliance on/testing of personal alliances
- Challenges to integrity, candour and principles
- Frequent of conflicts of interest
- Failure to reach agreement on wide-ranging issues
One of the predominant tasks of the partnership meeting is to reach important decisions that will determine the direction, procedures and policies of the practice with a view to providing the highest quality of patient care whilst maintaining a commercially aware, sustainable organisation, with a strong and dedicated workforce. The meetings will need to possess the flexibility and adaptability to respond effectively to all manner of internal and external challenges over the short and the long term. To do this effectively requires a decision making forum that is capable of arriving at transparent, concordant, coherent and determinative decisions for onward communication to those responsible for their implementation.
Resolving the Differences
Any deep misgivings from partners who feel troubled about an individual decision should be averted, not least as this may well have a negative impact on the prospects of successful implementation. The key to achieving this type of unity and to encouraging greater harmony is through inculcating in the individual partners an acknowledgment that certain situations may arise where they need to subordinate their own views to those of the majority. The recognition and acceptance of the need to compromise is a fundamental feature in any decision making forum, not least in partners’ meetings in larger GP practices. It should be stressed that compromise does not indicate an unchallenged approval of the decisions of the majority. Instead, it denotes yielding what may be long and deeply held principles and convictions to the overall benefit of the practice.
The Conduct of the Meetings
To reasonably ask partners to do subordinate their views to those of the majority necessitates providing them with the necessary material to enable them to make a conscientious and unbiased analysis on the relevant facts, which have been given freely, clearly, transparently and impartially. They should also be encouraged to express their reservations and explain the reasoning behind their opposition. If an objecting partner is to compromise it should be willingly entered into, rather than under compulsion.
The importance of the role of the Chair cannot be overstated in this process. The Chair will be key to creating an atmosphere within which all participating partners will feel that were present at a meeting where their position within the practice and their views on its operation have been recognised and endorsed and that their views and arguments have been listened to, even though they may not have been accepted by the majority. The partners may well wish to bear this in mind when electing a Chair.
It is fundamental that any partner meeting is highly structured with clearly defined areas for discussion each one leading to clearly agreed and defined actions. Each area for discussion must have a time limit put against it that must be rigidly adhered to so that there is no scope to go off piste and the meeting will remain focused.
Identifying conflicts that impact adversely on the effective performance of partners’ meetings should be achieved through either an external or internal audit. The efficacy of an internal process will depend largely on available resources and the expertise of and confidence in the partner and/or non-partner team that is delegated to conduct it. Whichever method is used for undertaking such an appraisal appraisal, through the recognition of those sources of conflict that exist, the introduction of a climate that encourages compromise and skilful chairing of meetings, the effectiveness of the management of the practice, through the forum of its partners’ meetings, will only be enhanced.