The partners who ran the practice were reluctant to commit the capital to expand—some wanted to wait and see how successful their competitors might be, some felt that they could live with lower earnings if that’s what resulted, and some wanted to seize the opportunity to capitalize on new market opportunity but without taking personal financial risks.

Those who wished to expand sought an outside private equity investor to bankroll growth.  This put practice leadership into crisis, and the day-to-day operations of the clinic started to suffer with staff defections and increasing levels of patient complaints. At the same time, one of the practice’s high profile physician leaders decided to join the competition and took some staff with him.

I worked with the practice’s managing partner to understand exactly what was at stake with respect to the deteriorating leadership situation and what personal and group dynamics were impacting performance. But before we could address the organizational dysfunction, we had to understand the strategic situation more fully.

• What clinical operations would be under greatest threat? How great was the upside opportunity for expansion?
• What, exactly, were the group’s competitive options?
• Where was the practice making money? How much time did they have before starting to lose market share?
• Were partnerships and alliances with other regional hospitals possible so that the risks and costs of expansion could be mitigated?
• What staffing and other resource needs would change as a result of the practice’s expansion?
• What governance changes would be needed? For example, could the practice do a capital call among the willing partners and change the ownership structure without negatively impacting performance?
• How would the next generation of partners view any changes and would they vote with their feet, further weakening operations?

It’s often the case that personal and team development work can only be done once major strategic and operational choices have been considered if not resolved.

With greater clarity and some tentative alignment among the managing partners about how to proceed…

• I led a diagnostic process to identify those leaders who were best able to accept the current situation—those who were comfortable enough with themselves to step outside of any narrow personal interests and focus on shared problem solving. They became the focal points for meaningful conversations that led to positive change.
• As part of this, we focused on cultivating greater present moment awareness among the partners as to what was happening in the room as they deliberated alternative futures for themselves and their staff. I asked them to check their own biases and envision situations where they felt secure and fulfilled in their work and able to help more patients, which is why most of them had become physicians in the first place.
• We looked at individual career trajectories, lifestyle considerations, and personal and professional growth goals to arrive at a new model of practice leadership that enabled manageable organic and external growth.

This is a great example of how blending rigorous analytical work with mindfulness principles and practices can lead to more satisfying and sustainable personal and organizational success.