Survivor, Practice-style: Triangulation

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This has been a topic of conversation lately. And while it may be fun to watch on Survivor, the gossip, taking sides, stirring of s@#$%t that takes place in a practice can be toxic and damaging.  I dug up an article that Sandy Roth wrote a while back and with her permission, pass it on to you:

Triangulation and Forming Alliances: How to eliminate it

Why can’t we just get along?  I suspect one of the reasons is that we don’t know how. First, the fancy definition: Triangulation occurs when one person, having an issue with a second person, takes that issue to a third person. Now for the street version: Triangulation is talking about people behind their backs.

Triangulation is a serious problem for many teams, and it can often get a group in big trouble. Although triangulation is a behaviorally immature approach to disagreement, many adults engage in it without understanding the full implications of this choice. When I observe this behavior, I ask about it. Often, team members are simply unaware of what they are doing. They have learned to gripe but not to address their problems directly; so they simply do what they have always done.

•  Triangulation solves no problems

The only route to solving inter-team conflict is a full, honest and open discussion of the issues with every person’s active participation. All problems ultimately belong to the group and not a secret subset of team members. Here’s why. Let’s say Jeanne and Jane have a difference of opinion. When their individual efforts fail to resolve this difference and either party secretly takes her frustration or anger to a third person, that third person is now involved in a clandestine discussion. This unhealthy dynamic now “infects” the entire team. People always know who is mad at whom and who is part of a faction.

•  Triangulation creates new problems.

Triangulation fractures the group by putting a greater emphasis on differences than on understandings. It almost forces people to focus on the negative aspects of their culture. Moreover, this strategy creates an environment of distrust and disrespect, which tends to undermine healthy aspects of relationships. Practice attention must then be shifted from patient care to team dynamics. What a waste.

•  Triangulation creates false alliances.

Jane is angry with Maggie and goes to Susie to dump. “Have you noticed Maggie doing such-and-such?” Jane asks Susie. Now, Susie hasn’t noticed this, and initially she has no beef with Maggie herself. “No,” she answers. “Well, I have,” adds Jane. At this very point, Susie will most likely make a choice between aligning herself with Jane or standing in defense of Maggie. Susie will find it difficult to disagree with Jane. After all, Jane has come to confide in her — an act of “friendship.” And just because Susie hasn’t seen something doesn’t mean it hasn’t really happened. Human nature will more often result in a secret alliance between Jane and Susie against Maggie which is based on  incomplete information and a pact to tell no one else. If she tells Maggie, she has violated Jane’s “confidence.”

The confidential information Jane has shared is now almost impossible to ignore. (Don’t think of an elephant.) Even if Jane drops the conversation at this point, Susie is now predisposed to seeing Maggie in the negative light of Jane’s characterization. She is now more likely see those things which confirm Jane’s picture of Maggie and selectively ignore information to the contrary.

  Triangulation encourages factions

Under the guise of “checking it out,” a team member triangulates with a third party (Sometimes this person is the dentist). First, let’s agree that this is tattling. If the initiator really wants to check things out, he or she can go to the only person who can answer the questions. The real purpose of this behavior is to gain allies. The more people who agree that you are right and the other is wrong, the stronger you feel and the more righteous you become. Once the number of allies begins to grow, the opposition is forced to counter. Before you know it, the practice is split and there is a full-scale civil war.

So what are the alternatives?

  Always go to the source

The cleanest way to handle any problem is to go to the source. Yes, this can be tough, but eventually the problem will have to be aired anyway and it won’t get any easier under the unhealthy circumstances triangulation creates. Forget about rehearsing, making sure you are “right” before you raise an issue or gaining evidence. None of these excuses justify triangulation.

•  Never agree to keep triangulation confidential

If someone asks you to enter into unhealthy alliance by sharing secret information with you, simply refuse to keep it secret. The proper answer to “If I tell you something, will you promise not to tell anyone else? “ is “NO.” For what honorable reason would someone call your attention to a problem if she didn’t want some help actually solving it? If the real reason is to get your support in the civil war, refuse to be drafted. You can agree to help the person raise an issue, but you must never agree to be a secret-agent.

•  Ask for facilitation if you need help

If a co-worker tells you about an issue she has with a team member ask the following: “How did you raise that issue and what happened as a result of your discussion?” Too often, you will hear that there was no discussion. At this point, encourage your friend to raise the issue immediately and offer to facilitate the process. Facilitate does not mean gang up. Facilitate means to insure that each party is heard and understood.

•  Return the problem to the group if  necessary

Of course the team needn’t handle every issue. But when reasonable attempts to resolve disputes prove unsuccessful, it is time to ask for support from the entire team before the relationship deteriorates needlessly. Be sure to ask team members to listen to the issues and avoid taking sides. The only side which matters is the onein the best interest of the practice as a whole and the patients whom you serve. Principles, core values and promises to patients matter. Egos must get out of the way.

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