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.
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When I toured the lounge, I saw a poorly lit room with worn furniture – a small cluttered desk with one phone, an outdated desktop computer, and a thermos of coffee with a short stack of Styrofoam cups on an end table.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.
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.
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.
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.
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.
The culture of healthcare organizations continuous to be in a vicious cycle of self-perpetuation in an organizational climate of mistrust, miscommunications, finger pointing, discrediting and hoarding of control.
Dysfunctional behaviors are condoned and rewarded every day by performance reviews not given, salary increases, budget appropriations and contract approvals. Healthcare culture appear to be in a survival state of defensiveness, physical slowness and mental dullness.
Why is it so hard to see and feel the confidence and courage in the board of trustees, hospital management and medical staff leadership who everyday, whether they realize it or not, by their daily actions, create or reinforce the culture within their organization?
The board of trustees must step up and become accountable for setting in motion a process for renewing their organizational current culture by re-aligning key stakeholders’ roles, expectations and behaviors for themselves, hospital management and medical staff leadership.
Most boards do not know they are accountable for their organization’s culture, they rely on their CEO for recommendations and continue operating in a traditional hospital governance model – which in most cases is the status quo.
Board members, CEO, Senior Leaders and Medical Staff Providers need to examine together real experiences that constitutes their current attitudes and behaviors when they interact with each other. Determining functional relationships is about being in sync and aligned with clear roles and agreed on expectations.
The board of trustees are responsible for discussing the following:
First and foremost the board of trustees must require accountability of itself, hospital senior management and medical staff leadership. In doing so, working together as business partners modeling direct, honest and open communications, establishes the beginning of new rules of engagement, which starts with individual accountability, which shifts the organization to the desired culture.
Reality check – If health care organizations are going to succeed in their current environment it will require board members and their CEOs to reassess their understanding of the board’s accountability to its community; its governance model; its strategic plan; its responsibilities for clinical quality; patient safety, finances, patient, physician and employee satisfaction and its ability to assess the recommendations and performance of executive management.
Never before has there been more of an emphasis placed on Trustees leadership skills, business acumen, risk management, collaboration, diplomacy and the ability to think and act proactively.
Health care organizations are staggering from regulations to reimbursement, medical treatment advances to an aging population.
How should boards approach their responsibilities today with the relentless fast moving stream of changes?
How do you find out if their board and its members are being held accountable for their role responsibilities?
Best practice strongly suggests annually conducting an Individual Board Member Performance Self-Assessment.
It is essential for the board to take a timeout each year to think about and rate their own performance. This self assessment is not about the performance of the CEO or the management team. The purpose is to evaluate the board’s satisfaction with aspects of its performance and to be candid on the areas needing improvement.
The objectives are twofold:
Self Assessment questions range from 15 – 20 questions with a rating scale #1 Disagree, #5 agree #10 strongly agree. Each question includes, “How can we improve?”
Each trustee independently and anonymously rates the board’s performance on the set of questions, i.e., “Our board has developed trustee performance expectations that are shared with new candidates and used annually as part of the ongoing performance assessment and reappointment.”
Effective boards take the time and expend the effort to ensure each trustee has a clear understanding of their role and responsibilities and understands the performance expectation the board has of them. Having informed, engaged trustees committed to continuous learning and performance improvement is essential to the board’s effectiveness.
Board members must be responsible for making a contribution and for their own behavior – being on time, coming prepared, asking good questions and engaging in constructive discussions and decision making. It only takes a single director’s dysfunctional behavior to undermine the entire board’s ability to work together and do good work.