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When reform was passed last year, the board for Silver Cross Hospital, Joliet, Ill., wanted to know as much as possible about how it would affect the hospital. Our trustees saw an opportunity to leverage reform and new payment paradigms for the benefit of our patients, their families and the community. Improving quality and patient satisfaction and lowering costs was the call to action.

Getting their arms around reform wasn't going to be easy. Management gave a presentation to the board, and the two groups had a good exchange of information; however, it was a lot for the board to absorb at one time. But this meeting was just the starting point. Senior managers knew they would be giving trustees additional learning opportunities at an upcoming retreat.

After the retreat and additional informational sessions, the board and medical staff discussed how to position the organization and its physicians for continued success. They realized that delivering quality care in the future would require changing from a volume-based system to a value-based system in which independent physician practices and an independent hospital would join in a clinical network to improve quality, boost physician incentives, coordinate care across settings, electronically share data and manage the health of a population.

To identify a strategy to address these changes in the near term, the hospital formed a "guiding coalition" of two board members, 12 physicians and four senior administrative leaders who would bring recommendations to the full board and entire medical staff.

The coalition is an example of how hospital trustees, administrative leaders and physicians can get out in front of reform issues in a timely and collaborative fashion. Much of the legislation is clinically oriented, and physicians and board members on the coalition understand that the opportunity to improve care is right in front of them.

Coalition members have had several strategic planning discussions to lay the foundation for the value-based strategy. From these discussions, members have developed five strategic imperatives that will guide the organization's decision-making as reform evolves.

The five strategic imperatives are: determine the optimal strategy for hospital-physician alignment; identify physician leadership; expand the technology platform for quality reporting and data sharing; educate medical staff; and investigate options for partnerships.

The coalition currently is considering a strategy for hospital-physician alignment and is weighing three options for a physician-hospital organization:

  • 100 percent hospital-owned organization with physician-shared governance, where physician leaders are elected by the medical staff
  • A joint venture with physicians as owners and with equal physician representation in governance
  • Physicians as passive investors (less than 49 percent ownership) with shared governance, where physician leaders are elected by the medical staff

Regardless of the coalition's output, this exercise has improved trust, transparency and communication among the board, management and the coalition's physicians. It also has given board members an understanding of how hospitals and physicians work together. Collaborating has been informative and instructive for board members.

The coalition's term was only three months, and the board expects to implement its recommendations this year. If that happens, trustees will want regular updates on key success indicators such as quality and financial data. If the physician-alignment strategy is successful, the board will be engaged in bigger projects as reform moves along.

The board's mission is to ensure the highest quality care for the community. Our board always has been involved with quality, and trustees understand core measures and outcomes. They also realize that, even though we are a Top 100 Hospital, the bar on quality keeps moving higher, and we have to rise with it. In addition, they need to be aware of the risks involved in the decisions they make and to ensure that the hospital remains viable, is positioned well and has a plan for potential risks. The coalition has helped us do that.

We still don't fully know what form health reform finally will take, but we have taken the necessary steps to lay the groundwork for informed, strategic decision-making.

Paul Pawlak ( is president and CEO of Silver Cross Hospital in Joliet, Ill.