Strengthening Alignment Between the Board and Physicians

A Mutual Commitment to Collaborative Behavior

In order to achieve the outcomes outlined in this document, a change in attitude and behavior is required of all parties. The following are examples of the types of commitments required of all parties in order to strengthen the collaborative relationship between the board, physicians, and management.

• Focus on areas in which common mission, vision, and objectives are possible; rather than on the differences and barriers that exist.
• Learn to respect the differences of values, viewpoints, interests, and opinions that exist among and between physicians, board members, and managers; and strive to learn something from what others have to offer before disagreeing with them.
• Recognize that all individual perceptions are incomplete and that no one has access to the full truth. Work to collect the facts and clarify the intentions of people before behaving as if you know exactly what happened and why.
• When a problem develops due to something that someone else has said or done, go to them and openly discuss what happened.
• Support those who are willing to demonstrate some leadership; and offer suggestions and coaching instead of resistance and criticism.
• Try harder to catch people at what they are doing right; rather than focusing on what they are doing wrong.
• Consider the possibility that someone else's approach might work; and be willing to examine options and to compromise.
• Make commitments and be willing to be held accountable for achieving some positive outcomes.
• Speak openly and in a straightforward manner; but listen, listen, listen.
• When a mistake is made, assume responsibility and admit it.

Physician Membership on the SRHC Board

1. The intention related to having a substantial percentage of physician board members is to ensure that the Board has ready access to the perspective of physicians and the unique knowledge and expertise that they possess. All physician board members, both those in 'ex-officio' positions as well as those who are nominated by the Board, are encouraged to actively participate in all board discussions in order to help ensure that the viewpoints of physicians are carefully weighed as the Board makes its decisions.

2. Like all other members of the Board, physician board members are expected to meet a set of baseline requirements of individual board members. The Governance Plan provides a written role description that clearly articulates the expectations of all board members.

3. Physician board members who are at-large members do not sit on the Board as representatives of the medical staff or of any sub-group within it. While expressing their viewpoints as physicians, they are expected to support decisions and actions that are judged to be in the best interest of the institution and the local/regional community. On the other hand, the elected Chief of the Medical Staff has 'ex-officio' board membership (with a vote) due to his/her elected positions within the medical staff. This physician board member should be expected to voice the concerns of the medical staff as a whole, as well as the interests of individual sub-groups, during board deliberations. However, when he/she votes, he/she must also vote in support of recommendations that are in the best interest of the organization.

4. The Nominating/Governance Committee of the Board should be responsible for identifying and recommending both laymen and physicians to serve as Board members. (The slate of physician nominees should come from the Medical Staff Executive Committee to be reviewed and approved by the Governance Committee.) The membership of the Nominating/Governance Committee should always include at least one physician. On an annual basis, each member of the Board, the medical staff and senior management should be formally invited to present names for the Nominating/Governance Committee to consider when nominating both lay and physician board members for either re-appointment (each board member serves a four year term and the number of consecutive terms should be limited to three consecutive terms) or initial appointment.

5. Consistent with the manner in which it works with its lay board members, the Board should do the following in order to help individual physician board members make a substantive and appropriate contribution to the work of governance:

a. Ensure effective orientation and on-going education related to governance.

b. Monitor individual performance (attendance, participation, overall contribution), work actively to ensure meaningful contribution to the work of the Board, and address problems related to the same if they develop.

c. Discuss openly how communication related to major strategic decisions will happen, and whether or not it is appropriate for individual physician board members to assume a lead role related to facilitating such communication with the medical staff.

Strategies for Strenghthening Relationships Between the Board and Physicians

1. Continued efforts should be made to simplify the medical staff structure, reduce the number and frequency of committee meetings, and increase the overall effectiveness of the medical staff organization. Hopefully, such on-going efforts will enable more physicians to devote the time required to governance and to the work of key committees and task forces that shape strategic decision making.

2. The role of the Vice President of Medical Affairs should be shaped in a manner that ensures that the position will serve as an effective formal link between the organization and physicians..

3. Full meetings of the Medical Staff, as well as meetings of clinical departments, should be utilized to communicate with physicians related to major strategic initiatives in order to keep them informed, get their input, and test recommended actions prior to implementation.

4. The medical staff leadership should be encouraged to schedule an occasional extended meeting or retreat to reflect on changes occurring within the healthcare environment and to develop annual objectives and action plans designed to increase the effectiveness and ensure the success of the medical staff organization.

5. In order to strengthen the communication between the Board and the Medical Staff as a whole, the following actions should be taken:

a. As a general practice one of the at-large physician board member should provide an update on board activity at every meeting of the general staff.

b. Individual members of the Board should be scheduled to attend at least one general meeting of the medical staff on an annual basis.

c. Joint dinner meetings including the Board, the medical staff, and senior management should occur periodically. These meetings should be structured as educational meetings within which significant dialogue is to be encouraged.

d. Board retreats should be conducted on an as needed basis; and these retreats should be open to a broad representation of the medical staff and of individual physician practices, not just the Officers and members of the Medical Staff Executive Committee.

e. Attendance at state, regional, and national education programs by physicians, board members, and management should be encouraged.

Other activities should be sponsored to help board members and physicians get to know one another and to provide opportunity for conversations about the organization, healthcare, and the future of medicine.

Content Provided by
The Bristol Group

 

 

Shaping the Future of Health Care
33 Fuller Road • Augusta, Maine • 04330 • tel 207-622-4794 • fax 207-622-3073