Center for Healthcare Governance - Monographs 2008
Healthy Board/Medical Staff Relationships: Current Trends & Practices
Overview: In today's rapidly changing health care environment, one of the most pronounced trends is the evolution of hospitals and health systems toward an integrated delivery model of care. An integrated delivery system implies an increasingly close relationship between doctors and health care facilities.These facilities may employ physicians directly or contract for their services. But, whatever the financial arrangements, integrated systems seek to provide a seamless continuum of patient care that requires a strong bond between physicians and hospitals.
Physicians are critical to the success of an integrated delivery model of health care because they are a key point of contact between the organization and the public. While many hospital employees also play a front-line role, no other resource will have a greater impact on a hospital's reputation and market share than the perceived quality of its physicians.
Care delivery in a hospital or health system has characteristics similar to a theatrical production. Hospital management are like theater personnel who operate "behind-the-scenes"--writers, producers, directors, set designers, and box office staff. Physicians, however, are the actors who bring the play directly to the audience. No matter how good the scripts or sets, how the audience perceives the actors will in large measure determine the critical and commercial success of the venture. Given their "leading roles" actors will often want to have input not only about their own performance, but also about every aspect of the production that affects it. Such input may seem unrealistic, but directors disregard it at their peril.
Physicians in a hospital or system sometimes operate in a similar fashion.The challenge for executives and trustees is to address physicians' concerns in the context of their fiduciary obligation to the organization as a whole. One of the best ways to accomplish this is to increase physician contact with the governing board.
Board/physician involvement can take a variety of forms, from discrete presentations to committee service to actual board membership. While most health care organizations have physician representation at the board level, with the chief of the medical staff serving in an ex-officio role, such representation is not automatically a panacea for improving physician relations. Much will depend on the spirit in which the individual physician executes his or her governance responsibilities. If physician board members see their role as primarily constituent-driven, that is, as a voice for the medical staff, then they will not always govern in the best interests of achieving the organization’s community-focused mission. Board membership requires a holistic view and brings with it a responsibility to the organization as a whole and the patients it serves.
This publication presents the results of a survey of board/medical staff relationships and findings from focus groups that offered strategies health care organizations are using to improve them. It can be used as part of board orientation, as background reading for leadership retreats, and as a resource for board members and physicians participating in joint meetings and other leadership initiatives.
We hope the results of the survey and focus groups will not only shine a light on the issues and challenges facing these leaders, but will also provide new thinking and approaches that all boards and medical staffs can employ to strengthen their leadership partnership.
Healthy Board/Medical Staff Relationships: Current Trends & Practices