Part 2 of 2
This article is a sequel to part 1, “Which physicians make the best board members?”
Many physician board members see the big picture and try to contribute to the organizations they serve. However, their ability to offer value depends on a number of factors. Here are some pointers to help your board maximize the impact of physicians’ efforts. Keep in mind that some of these tips may be applied “across the board” to improve governance overall.
Fine-tune your recruitment process.
- Consider competency-based selection criteria for every physician except ex officio.
- Prioritize selection criteria in part 1 by reviewing your organization’s mission and strategic objectives.
- Clarify roles, expectations and duties as part of the recruitment process.
- Use the same amount of rigor that you would recruiting for other board positions.
- Investigate all possible conflicts of interest, and have candidates sign a conflict-of-interest (COI) statement. For example, you may learn by disclosure that a physician is invested in an outpatient surgery center. Too many conflicts should disqualify a physician candidate.
Gain power in numbers.
- It’s important to bring on physicians who are systems-thinkers vs. practice-centric. However, putting aside practice patterns and natural allegiances (e.g., to the medical staff or a group practice) can be tough.
- Keep this in check by increasing the number of physicians on your board. One strategy is to make sure you have varied representation among your physician board members – internal and external; retired and employed, etc.
Provide a rock-solid orientation.
- Although orienting all new board members is best practice, customize the experience and training for physicians.
- Help new board members understand your organization’s purpose and key stakeholders (e.g., patients, employees, partners, legislative bodies, community).
- Explain each members’ legal or fiduciary duties, especially the duty of loyalty.
- Review all roles during annual retreats. If you have employed and non-employed physician board members, educate the board on both types.
Be inclusive.
- Give physician board members meaningful committee assignments just as you would other board members.
- Invite them to all educational opportunities. Although they may have a wealth of knowledge in medicine, they may not be up to speed on your organization’s inner workings or its governance challenges.
Develop black-and-white, conflict-of-interest (COI) policies and procedures.
If COIs arise, have a clear plan in place on how to address. Ways to tackle include:
- Disallowing the physician board member from voting on an issue where there is a conflict.
- Recusing the physician during board discussions involving the conflict.
- Keeping information about the COI strictly confidential and away from the respective physician.
- Dismissing from the board physicians with continual conflicts that cannot be cured any other way.
Listen carefully.
- Physicians offer a unique perspective to the board. They also have key insight about the medical staff – which can make or break an organization. When they voice a medical staff concern, please don’t take it lightly. This, in effect, is your “early-warning” physician-relations system. Some of my most impactful and valuable experiences included taking physician and non-physician board members to an educational session, and letting them engage later in dialogue, over dinner.
Embrace physicians’ highest concerns.
- At the top of most physician board members’ minds are quality of care and safety. In an effort to stay in line with physician thinking, consider placing these items at the top of your agenda. These items should rank equally with finance. Some hospitals have a physician chair the board quality committee.
- In addition to quality and patient safety efforts, physicians also should be involved in strategic planning.
- Encourage non-physician board members to attend medical staff meetings when invited. A best practice I’ve seen is having non-physician board members attend the medical staff’s credentialing committee periodically (e.g., once every year or two).
Make the most of physicians’ time.
- For many physicians, time is a luxury. Maximize board meeting time. For example, use committee dashboards and scorecards and/or have approval agendas. Don’t spend meeting time listening to committee reports. Most physicians by nature tend to prefer transparency, honesty, accuracy, efficiency and straightforwardness.
Reinforce continual learning.
- Encourage physicians to obtain leadership training or earn an advanced business degree such as an MMM, MBA or MHA. I consider providing appropriate leadership education for physicians a best practice that helped propel many organizations forward.
- National organizations like the American Association of Physician Leadership, Medical Group Management Association and American College of Healthcare Executives offer a wealth of educational resources, including training sessions, retreats, conferences and certifications.
- Independent firms, like Practical Governance Group, also offer online and on-site training and consulting. American Hospital Association’s Center for Healthcare Governance also would be a great place to start.
Implement self-assessments.
- In lieu of board terms that could eliminate an effective physician board member or keep on a poor performer for a set term, consider self-assessments. Yearly is ideal, but at a minimum, conduct every other year.
- Self-assessments not only provide all board members the opportunity to improve, they also sometimes uncover the elephant in the room, or an issue everyone knows about but doesn’t want to address.
After decades of serving on boards wearing a colorful array of hats – hospital CEO, board chair, physician board member, and more – my hope is that implementing some of these practices will help your organization’s board, and enable fulfilling and impactful board experiences for your board members!
Frank D. Byrne M.D., MMM, FACHE, FACPE, FACP, FCCP, offers more than 40 years of experience in leadership and governance roles. In addition to being an associate at Practical Governance Group, he is president emeritus of St. Mary’s Hospital in Madison, Wis. Among his accolades, Modern Healthcare and Modern Physician magazines named Frank in 2011 one of “50 Most Influential Physician Executives in Healthcare.” He began his career in pulmonary and critical care medicine. Follow Frank on Twitter, and reach him at 904-606-5744 or fdb3md@gmail.com.