Viewpoint
Physician Trustees: Maximizing Their Contribution to Governance
By Spence Maidlow
Hospital boards often rely on their physician members to help them better understand their quality oversight responsibilities. Yet boards that look to their physician colleagues primarily as quality experts are missing the broader contributions they can make toward helping the organization accomplish its mission. Physicians, as drivers of clinical care decisions with front-line access to patients can bring important perspectives to the board, if given the opportunity. Providing that opportunity and supporting physician trustees to maximize their governance contribution should be one of the CEO's key responsibilities.
Physician Orientation
Setting the stage for physician trustee effectiveness begins with the nomination process. The CEO should be a voting member of the board nominating committee to select potential physicians with the skills and attributes needed to make a positive contribution to the board. All board members need to appreciate the importance of the organization's culture and encourage investment in that culture. They need to be good listeners, able to take a long-term, strategic view, understand and appreciate the complexity of the organization, and hold management accountable for results.
These skills frequently diverge from those doctors most often rely on in their medical practices: large organization communications are more involved; financial issue are more complex; and usually, a greater number of people participate in setting goals and meeting them.
CEOs should be aware of the unique challenges physician trustees face when they join the board. For example, physicians usually don't have the organizational skills and perspectives that other board members who are business people can bring to the table. As part of physicians' orientation, CEOs should provide them with resources and educational opportunities to help fill in information gaps about such subjects as market share analysis, marketing, human resource management and finance--all areas that fall under the board's purview.
Physician Development
As important as a strong orientation is, education cannot end there if physician trustees are going to make a significant contribution to the board. Ongoing education for all board members, including physicians, should address such topics as: industry trends; community's environmental assessments; the capabilities of medical specialists and hospitals in nearby communities; and the market share of their own and competing organizations.
Through individual performance assessments, CEOs also should be attuned to the specific educational needs of physician board members, helping them get the information and skills they need. CEOs should also encourage the special contributions physician board members can make, such as their insight into improving hospital-physician relationships. For example, physicians are skilled at interpreting the results of physician satisfaction surveys and can contribute significantly to action plans developed to address those surveys.
To further develop physician leaders, Covenant Medical Center, a 520-bed facility in Saginaw, Mich. (part of Covenant HealthCare, the state's largest health care provider, serving communities in 14 counties), has implemented a physician leadership academy that uses both didactic and interactive classroom work, including a case study in which physicians make decisions about the expansion of a small business. This case-study approach provides physicians a chance to deal with issues that hospitals face as they expand programs and services.
Over a 13-month period, 25 physician leaders at a time learn about industry developments, insurance and hospital finance, large-organization decision-making, and how to get the most from working relationships.
The idea for the academy sprang from our recognition that promising clinicians are often asked to make decisions about important political and business health care matters without regard to their preparation for dealing with such issues. The academy is therefore intended to educate physician board members, the current cadre of elected medical staff officers, and those younger leaders who are likely to become the medical staff officers and department chairs of the future.
Outside experts and members of a local consulting firm teach academy classes. As part of the curriculum, participants can go through a 360-degree personal assessment that includes feedback from their elected leaders, physician colleagues, and nonphysician co-workers. Feedback relates to: communication skills (e.g., does the physician listen carefully to others?); people skills (e.g., is the physician aware of others' feelings and reactions?); attitude (e.g., is the physician approachable when under pressure?); and leadership (e.g., does the physician encourage the participation of others and build enthusiasm for new ideas?).
Unfortunately, most physicians have few opportunities to receive honest, unfiltered feedback that reveals their strengths as well as their blind spots. A professional facilitator associated with the Covenant academy provides a confidential interpretation of feedback data and helps doctors develop an improvement plan. An overwhelming majority of physicians in the academy have chosen to participate in the 360-degree feedback process.
Graduates of the academy have expressed a high level of satisfaction with the experience. They say they come away with a greater understanding of the reasoning process used by the board and administration and are able to apply learned leadership principles to their private practices.
Physician trustees and CEOs should champion the establishment of such a program. It can contribute to enhanced skill sets, increased leadership capability, improved working relationships, and a higher-performing organization.
The Impact of Physician Trustees
Board members understand the rationale behind most major institutional decisions and can play an important role in building support for them. However, in a competitive hospital environment, it may not be feasible or appropriate to provide in-depth explanations of key strategic decisions to every doctor. Physician board members who hold a special status in the medical community as "wise old heads," and who have the benefit of participating in board decision-making can often allay medical staff concerns by reassuring colleagues that the board and administration know what they're doing. If such reassurance isn't effective, they can signal the CEO that more in-depth communication with the medical staff would be beneficial.
CEO Accountability
A robust strategic plan, solid execution of that plan and excellent working relationships among hospital management, employees and the medical staff all contribute significantly to the organization's success. These factors should also be part of the board's CEO assessment. Trustees who are practicing physicians have an appreciation of the hospital's performance that goes far beyond mere data analysis. They can often add concrete examples to CEO performance evaluation metrics. Physician board members add an additional valued perspective on hospital-community relations and should play a role in evaluating the CEO's performance.
With their in-depth knowledge of clinical quality and medical care delivery, along with the right orientation, education and support from the CEO, physician board members should be well positioned to maximize their contributions in all areas of governance.
Spence Maidlow is president and CEO of Covenant HealthCare System, Saginaw, Mich. He is a fellow of the American College of Healthcare Executives.
This article 1st appeared in the December 2099 issue of Trustee Magazine.
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