14 LarsonAllen EFFECT / Fall 2005

Physician Engagement in Hospital Governance Improves Performanceby Jim Rice

Reviews of U.S. hospital boards over the past three years reinforce the conclusion that fulfilling a hospital’s mission and maximizing its margin require more effective physician collaboration and trust. But just when collaboration and trust are needed most, hospital boards are finding these the most difficult to achieve. What factors frustrate or facilitate this needed physician collaboration? What can be done to rekindle and nurture collaboration and engagement?

Recent studies by The Governance Institute in San Diego acknowledge the growing importance of physician engagement in all aspects of hospital governance and the common factors that frustrate this engagement. Physicians cite five key frustrations that reduce the effectiveness of their participation in hospital board work:1. Lack of meaningful and sincere invitation to participate.

If physicians sense the board’s request to participate is only lip service, their enthusiasm and the quality of inter-action are constrained.

2. Time constraints. Unfocused and unproductive processes and meetings that are scheduled for the convenience of the non-physician board members demonstrate a lack of understanding of the physicians’ time limitations.

3. Lack of relevance to their practice. With technology and patient preferences changing, most physician specialties do not need the hospital as their workshop in the same way they did 20 years ago.

4. Lack of preparation for governance processes and decision-making roles. Physicians are rarely trained in teamwork, medical economics, or policy making. Resources are needed to optimize the physicians’ mean-ingful participation in governance work.

5. Lack of compensation. It is more difficult to ask for volunteered engagement when it appears to benefit the hospital more than the physician’s practice of patients.

Five strategies have been found to be useful in optimizing physician engagement and effectiveness:1. Board leaders must demonstrate to their physician

colleagues that they can learn to listen, and listen to learn.

2. Remove obstacles to physician participation. One of physicians’ most valued resources is their time. Strip away unnecessary meetings, reports, processes, and activities. Schedule meetings that specifically take into consideration the physicians’ availability and convenience.

3. Adopt a culture of openness: open door, open communi-cation, and open books. Even with the threat of informa-tion and insights leaking to competitors, err on the side of transparency as a first step toward building trust. Promote this openness as a two-way street for physicians to also share their plans relevant to the hospital’s well-being.

4. Keep your word. Building trust requires consistency and

reliability in agreements. Handshakes must be commitments that are understood and acted upon.

5. Provide staff and infrastructure that help build physicians’ “engagement quotient” (EQ). Make it easier for physicians to be more fully engaged in group work via smarter and leaner reports (all board members call for this). Call fewer—but higher quality—meetings that have meaningful agendas, provide useful information, and promote open discussion. Schedule some of the meetings around the physicians’ early patient care day (i.e., meet later in afternoon, after office hours).

There is risk associated with active physician involvement in hospital board work, however, the risks are much greater if they are not fully engaged. The five most common risk issues that arise as a result of increased physician engagement are as follows:1. As more physicians are tempted to participate in the ownership or

operation of competing care facilities, conflicts of interest may arise.2. Board members and managers may find it time consuming to support

physician participation.3. Physicians may ask disarming questions about why and how strategic

moves and investments are being made.4. Physicians may become more astute and assertive in their calls for

additional capital spending.5. Physician relations with staff and patients may unfairly leverage their

impact on developing or executing hospital strategy.

The Positive Circle of Physician EngagementThe pursuit of a higher physician engagement quotient (EQ) in hospital governance processes can generate a positive circle of results that improves the organization’s performance.

Acknowledging these potential risks and adopting the strategies of openness and engagement to minimize these risks will lead to enhanced hospital gover-nance and improved hospital performance. The movement toward involving and engaging physicians is a positive step, but we must continue to move forward if we hope to strengthen our nation’s health sector performance.

Jim Rice is a principal in the LarsonAllen Health Care Group. Contact Jim at jrice@larsonallen.com or 612/376-4571.