Center Voices
Criteria for Selecting Physician Trustees
By Erroll L. Biggs
Having worked with health care boards for a number of years, I have learned that boards would be well served to use several important criteria when selecting physician members.
As a general guideline, a hospital board needs to consider a membership comprising 15 percent to 25 percent physicians--going beyond the traditional president or chief of the medical staff, who usually serves in an ex-officio capacity and represents the medical staff's position. This percentage seems to provide a good balance between physician trustees and other board members as well as adequate medical input for the board.
Physicians understand the hospital's product line. They understand high-quality versus low-quality health care. They bring a clinical perspective to the board's mission, which assists the board in making better quality-related, patient-centered decisions.
Selection criteria for physician board members (other than the chief of the medical staff) should be basically the same as for other board members. However, when reviewing physician candidates, the nominating committee must always remember not to ask the medical staff for trustee recommendations. The chief of staff already represents the medical staff, so the board does not need additional physicians to represent that perspective.
Nor does it want to run the risk of a conflict of interest between the hospital and its physicians, such as a competing surgery center. As a first step, the nominating committee should not consider any physician candidates who have contracts with the hospital. This generally includes most pathologists, radiologists, anesthesiologists, hospitalists, intensivists, medical directors, directors of education programs, and emergency department physicians.
A hospital administrator told me recently that about 50 percent of his medical staff had some sort of contract with the hospital. I told him that made the nominating committee's decision 50 percent easier because it only needed to consider the other 50 percent for potential board membership. It also goes without saying that physicians who compete with the hospital in any significant way are not eligible.
Other worthwhile criteria for selecting physician board members include:
- Experience. The nominating committee should consider only physicians who have some type of previous governance experience, whether with physician organizations, banks, homeowners' associations or churches. The modern hospital is too important a community asset for people to learn governance there.
- Education. Many physicians are getting MBAs or taking business courses through professional organizations. The American College of Physician Executives (ACPE) now has more than 14,000 members and offers management and business courses to physicians. The American College of Healthcare Executives (ACHE) offers business and management courses to physicians regardless of their membership status in the organization. The right physician with this kind of education could be a real asset to a board.
- Collaboration skills. Team players can and do think collaboratively about issues, and are able to formulate opinions that integrate the perspectives of the team or board. There are always exceptions, but it has been my experience that primary care physicians seem to be better team players, probably because they have to coordinate patient care among numerous specialists and continually work to be a vital part of a team.
- Objectivity. As with the selection of all board members, the nominating committee must look for physicians who in no way represent any particular constituency, such as other physicians, a geographic area, or any one group of stakeholders. As with any board member, the physician's primary concern must be the good of the hospital and its patients.
- Commitment to the hospital. As it does with all potential board members, the nominating committee should be certain the physician under consideration believes in the hospital's mission and will take the time necessary to serve on the board. If any nominee to the board, including a physician, cannot commit to the necessary time required, he or she will be of no value.
In some instances, boards may feel it is better to go outside the community for physician members. Care should be taken, however, to ensure that the individual is not competing with physicians on the medical staff, and is not affiliated with a hospital in competition with the board's institution.
At the end of the day, having physicians on your board can help the board arrive at better decisions regarding quality of care, competitive strategies, and community health needs.
Who's the perfect physician trustee? One who is a good listener; has an MBA, MHA, MPH or other business or management education; is in primary care; has no conflict of interest with the hospital; has some board experience; and values collaboration. Who knows, he or she may even help the bankers, lawyers, and business people on the board better understand hospital financial statements!
Errol L. Biggs, Ph.D, is the director of graduate programs in health care administration at the University of Colorado, Denver. He can be reached by calling (303) 556-5845.
This article 1st appeared in the December 2099 issue of Trustee Magazine.
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