How Do Board Members Get to Know Their Medical Staff?

QUESTION: “How do board members get to know their medical staff providers without being perceived as micromanaging or going around management’s back?” This is a question often asked by board members who admittedly say they do not know their medical staff or how to approach them.

A board member shared with me that when she speaks with physicians, it often gets back to hospital administration and is perceived as going around management.

She was lost as to what she should do.

Business is all about relationships, but what if you are not in a relationship with your “rainmakers”?

When presenting on the topic, “How to Improve Hospital – Physician Relationships” at regional board of trustees conferences across the country, I always ask for a show of hands on the question, “How many of your physicians are associated with your healthcare facility because of their relationship with the board of trustees?” At four conferences, with 100 plus attendees at each, I counted only two raised hands.

When the following question was asked at the same regional conferences “…in relationship to the chief executive officers and their executive teams,” only one show of hands was noticed.

And when this question was asked “…in relationship to the nursing staffs” there was no show of hands.

In addition, when I asked, How many trustees had a board-driven policy declaring how they wanted their organizations to deal with their physicians?” – I had no show of hands.

Relationship Consequences

If key physician relationships are strained, fractured, deteriorating or plainly written off, you can clearly understand the reasons why. It may also be why the culture and values in healthcare relationships are deeply rooted with miscommunications and mistrust.

If the truth were known, many boards of trustees would not be comfortable dealing with physicians; hence, they avoid the encounter. While some boards may be at ease speaking with the few physicians they know, other physicians often perceive this contact as favoritism.

Likewise, many physicians do not know who is on the board of trustees of their healthcare organization. In addition and above all, many physicians do not know what board members responsibilities are.

If boards of trustees have not discussed and come to consensus regarding a policy on how they want the organization to deal with their physicians, they can easily be perceived as micro managers or bypassing management when they seek out physicians.

Rethinking Working Relationships

The relationship of the board of trustees with their physicians must be rethought and new strategies developed on how they want their organization to deal with their primary rainmakers.

Discussing and arriving at consensus on the following questions is essential:

  1. Should the board of trustees establish a relationship with their medical staff?
  2. If the answer is no, you need to understand why. And if the reason is “because that is why we have management” then you need to have a deep discussion about being accountable.
  3. If the answer is yes, then you need to discuss what those relationship will look like and develop a policy to improve the relationships with their medical staff providers to whom they have delegated patient quality assurance.

A facilitated board retreat with full discussion should center on:

  1. Identifying current perceptions that each:
    • board member has of his or her current relationship with the medical staff Providers.
    • medical staff Provider has of his or her current relationship with the board of trustees.
  2. What work relationship expectations does the
    • board need from their medical staff providers?
    • medical staff providers need from their board?

Creating New Relationship Expectations

Developing an explicit written “hospital – physician relationship policy,” describing the working relationship expectations each has of the other will certainly improve individual accountability, communications and trust.

A particular board of trustees, after full discussion amongst themselves, engaged the hospital’s executive team and their medical staff leadership to come up with the following action plans to establish their first ever “hospital – physician relationship policy.

  1. The board of trustees executive committee, chief executive officer integrates itself with the medical executive committee to establish a joint conference committee which meets monthly.
  2. The board chair, chief of staff and chief executive officer meet weekly to discuss strategies and operational issues.
  3. The board of trustees encourages the development of a medical staff leadership council, which is responsible for not only recommending clinical operations improvements, but also defining and prioritizing broad-base physician needs, and for upward and downward communications to and from the medical executive committee, hospital management and board of trustees.
  4. The new physician orientation and onboarding process includes attending and being introduced by the chief of staff at the board of trustees meeting.
  5. The board and hospital management have two major social functions a year for the full medical staff members and their significant others.
  6. Annually board of trustees will bring their medical staff leadership  together to assess their current relationships and develop the necessary action plans for improving their relationships.

Engaged Physicians: Critical Success Factor

Investing in physician engagement by institutionalizing a collaborative Hospital / Physician Relationship Policy that demonstrates between and among Board Members,  CEO, Employed and Independent Medical Providers:

  • Basic respect and inclusion
  • Functional working relationships
  • Communications protocols
  • Being responsive and receptive to providing high quality care for their patients

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