Category: Physicians

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

Perception Speaks Strongly When Expectations Aren’t Clear

In my experience conducting organizational key stakeholders’ relationship assessments, most physicians I have interviewed have the perception they are not the hospital’s #1 customer. They do know they have less influence and control over the hospital environment they work in – whether employed by the hospital or an as Independent Practitioner.

Physicians’ Perceptions

When I asked a family practice physician why he had this perception, he, in turn, asked me if I had seen their physicians’ lounge. He recommended I take the time to see it to understand what he meant.

When I toured the lounge, I saw a poorly lit room with worn furniture – a small cluttered desk with one phone, an outdated desktop computer, and a thermos of coffee with a short stack of Styrofoam cups on an end table.

Another physician related his frustration with the intensive care unit being sporadically opened and closed, noting the situation had been ongoing for a year. If physicians were the medical center’s #1 customer, he would not have lost the needed patient revenue for his practice nor had to inconvenience his patients and their families when he had to transfer them to an ICU at a competing hospital 90 miles away.

When I further inquired about the intensive care unit not being consistently open, I was told a staffing issue had been plaguing the unit. The medical center could not attract or retain critical care nurses and the situation was further exacerbated by staff absenteeism.

Physicians know they are their healthcare organization’s #1 rainmakers, yet many are not made to feel as if they are the most important contributor to the organization revenue stream. Most physicians realize the board and hospital administration have little clue to their needs or expectations nor for the organizational bureaucracy they encounter every day when implementing their clinical patient orders.

Transparent Reality

The attitude among the top-board members and management teams is very transparent and drives the organization’s attitude toward the physicians, which manifests itself in many ways by well-intentioned persons.

Most organizations rely on implicit expectations when dealing with physicians; these are unwritten and unspoken rules, requirements or understandings among people.

Board policies shape the way management and medical staff undertake their work. Boards are accountable for setting policy with directions and behavioral expectations. They must be clear in what they want the organization to do or refrain from doing.

Is your policy clear throughout the organization?

When was the last time your board of directors discussed and approved an explicit policy with expectations on how they wanted the organization to conduct and transact business with their physicians? If the answer is never, why not?

When people have a clear understanding of what is expected of them in providing customer service to physicians and meeting those expectations, trust grows and relationships develop. The opposite occurs when customer service expectations are not clear and not being met; trust diminishes and key stakeholder relationships become strained.

Do you have organizational consensus?

The board may have a policy consensus but that does not guarantee that hospital management and their staff agree.

Going back to the story shared by the physician about the conditions of the physician’s’ lounge – in the corrective action, the board and hospital management established an ad hoc committee of management and doctors to determine and recommend remodeling options.

Within 90 days, the lounge had a complete makeover which included new furniture, a kitchen area with food, coffee machine, etc. The dietary department became accountable for daily replenishment and environmental services was responsible for daily cleanliness.

The efforts by the board, hospital management and the ad hoc committee were well received by the physicians. Within a couple days of the lounge’s reopening, a nursing supervisor and a small band of nurses expressed a subtle resentment at the upgrade done for the doctors and not for the nurses.

Regarding the physician’s story concerning the inconsistency of the intensive care unit’s hours, the board and hospital management approved a physician-led ad hoc committee to determine action plans and recommendations to enhance the credibility of the ICU.

Within 90 days, a well-respected internal medicine physician assessed the ICU to determine both its strengths and areas needing change. He made the following recommendations: (1) become the unit’s medical director for one year, (2) schedule physician education for the unit’s nursing staff and (3) collaborate with nursing management to transfer the unit manager and find her replacement. Interestingly enough, nursing salaries were not a major issue. Hospital management collaborated to make the long-needed changes in the unit’s leadership. A formidable minority of employees perceived the physicians were now running the hospital.

Do you have organizational commitment?

Commitment begins with the board of directors being accountable for setting policy and expectations. People Employees look to their hospital management to take the time to share and clarify such expectations and consequences. Shared accountabilities create ownership and build relationships of trust and support.

Development of a “physician customer service policy” is the responsibility of the board. Its successful implementation is with the hospital management and their staff who must fully understand performance expectations and consequences when interacting daily with physicians.

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