Amid the stressful changes that hospitals and health networks must navigate these days, it's easy to focus on quick fixes and lose sight of long-term fundamentals. Among those fundamentals are the relationships between a hospital's board and its physicians, and one need not look far to see evidence that these important relationships have been strained. Physicians are pressed to keep up with growing case loads and diminishing reimbursements. Board members are grappling with the challenges of regulatory changes, compliance and operational efficiency. Both groups struggle with resource constraints.
As a health care management consultant, I've seen numerous situations where the relationships between hospital boards and physicians were more adversarial than collaborative, sometimes at the expense of outcomes. Health care's complexity tends to divide a hospital's internal stakeholders, despite their shared sense of altruism and community service. While administrators play a vital role in liaising between boards and physicians, direct communications and interaction are needed to develop and foster mutual respect, understanding and collaboration.
The development of a common language that leads to collaboration doesn't just feel better — it pays off financially. For example, the federal demonstration program of bundles reimburses hospitals and physicians via a single payment for the delivery of a surgical procedure. If the doctor and hospital collaborate to ensure an efficient use of resources and the delivery of high-quality care, those parties share any savings. But such rewards don't get done without strong relationships.
There is much that trustees can learn from physicians about clinical priorities and approaches, and much that physicians can learn from board members about strategic planning, administration and operational efficiencies. The potential for success through effective communication and collaboration remains great, but we must build or, in some cases, rebuild the understanding and trust that serve as pillars of mutual achievement. Boards must engage physicians, elicit their input and otherwise involve them in the strategic planning process. Administrators must serve as a partner in such endeavors, encouraging and facilitating direct communication between physicians and boards.
At Presence (formerly Provena) Saint Joseph Medical Center in Joliet, Ill., where I serve as board chair, and with strong support from our administrators, we have stepped up our interaction with physicians. The goal is to learn more about their responsibilities and concerns while giving them an opportunity to connect with our directors to gain a deeper appreciation for our challenges and objectives. We now start each of our board meetings with a clinical presentation from a physician. At one recent meeting, a physician showcased our neuroscience program. Until then, I had no idea just how successful the program had been and how much attention it had garnered around the country. We're learning from our physicians about the return on investment and potential in this area, and the experience has helped us to think in more visionary ways.
We also had no idea how much doctors would appreciate the opportunity to share their insights with our board, nor did we realize how meaningful this time together could be. We now have eager physicians scheduled a full year in advance to present to the board. But it's not all business. Some of our board members and physicians have developed social relationships. We have each other's phone numbers, and we call each other regularly. When you know someone and their kids, it's much easier to communicate and collaborate effectively.
In the interest of deepening those critical relationships with physicians and strengthening the delivery of high-quality, efficient care, I believe hospital boards have no choice but to aggressively pursue a model of informed activism. In other words, we must further develop our baseline competencies and embrace continuing education that equips us to make decisions in the best interests of our patients, communities and care-giving institutions. The Presence Saint Joseph board members have committed to a rigorous, two-year program that includes a regimen of at least 10 to 15 hours a month of reading and seminars as well as shadowing care providers.
I recently spent two days observing emergency department operations. I witnessed a wide range of patient problems — from attempted suicides and heart attacks to children with the flu and an older woman who had fallen, but really was more lonely than anything else. Of the 150 people who came to our ED in a single day, many had nowhere else to go for help; instead of emergency services, each needed a primary care physician. Still, each of these cases had to be triaged and addressed, which was physically and emotionally challenging for physicians and staff. And yet, I saw only remarkable courtesy and extraordinary care.
None of us can afford to become detached. Too much is at stake. Am I likely to be even more sympathetic in the future to the needs of our ED? You bet. I'm also going to work to redouble our partnerships with other care providers in our community who can help relieve our ED of patients in need of primary care physicians. My experience reaffirmed that our board can do more to serve the best interests of our patients and our hospital.
What's clearer to me now than ever before is the enormously positive impact that strong and trusting relationships between boards and physicians can have on managing today's challenges and shaping tomorrow's quality care. To be sure, fostering open and informative dialogue requires significant investments of time. The payoff, however, is nothing less than the fulfillment of our common mission.
Lyndean Brick (firstname.lastname@example.org) is senior vice president at Murer Consultants Inc., and is chair of the board of directors at Presence Saint Joseph Medical Center, Joliet, Ill.