Redesigning physician governance

“We are actively redesigning the way we deliver care to do what is best for our patients during this time of crisis. Some aspects of that redesign will likely persist after the crisis has passed,” said Dr. Tom Lee, Press Ganey Chief Medical Officer, in a recent NEJM article titled “Creating the New Normal: The Clinician Response to COVID-19.”

Indeed, with the dramatic impact that COVID-19 has had on institutions’ financial performance and the widespread and growing use of virtual meetings, there is perhaps no better time than now to redefine how, when, and where physician input can be more fully incorporated into organizational decision-making. In the bygone era of face-to-face meetings, physician availability was frequently cited as a major barrier to broader involvement in decisions large and small. The shift to the virtual landscape—for everything from delivering patient care to attaining CME credits—provides an opportunity to redesign physician governance and improve physician engagement. Organizations can start to lay out redesign plans by developing shared expectations, establishing just representation, and building capacity to execute and sustain these plans.

Designing shared expectations

Simply inviting physicians to attend a meeting, virtual or otherwise, does not constitute involvement; it merely indicates attendance. To realize the potential of physician governance redesign, organizations first need to clarify expectations regarding physician engagement and input. The breadth of decision-making authority will necessarily differ at each organization based on its management philosophy. While some organizations have clearly articulated a management philosophy, many have not. Fewer still have articulated a clear scope for physician engagement or even a clear set of mutual expectations and obligations among and between administrators and physicians. 

A notable exception is The Andrews Institute for Orthopaedics & Sports Medicine, an affiliate of Baptist Health Care, in Gulf Breeze, Florida. When Dr. David Joyner joined the organization in 2015, he was tasked with reimagining its culture. As an essential and pivotal early step in that journey, Dr. Joyner established a charter that clearly connects physician behavior to the mission and values of the organization and articulates the expectations for physician engagement in organizational decision-making. The charter, and the shared understanding and shared accountability it expresses, have not only improved operations but also dramatically improved physician engagement and patient care. Through the process of creating a charter or compact, organizations can identify the specific strategic areas where physician input needs to be expanded.

Establishing just representation

Once clear expectations are created, the next step is to establish just representation in the decision-making processes. Oftentimes, discussions about physician representation center primarily on medical specialty. However, medical specialty is but one lens through which any organization should evaluate representation.

As an example, Press Ganey research shows that female physicians score “involvement” substantially lower (and among the lowest scoring items of all) as compared to their male physician counterparts. Better female representation in governance can also help influence and give voice to some of the significant challenges faced by this group. Decisions about improving representation in the short term have long-term impacts for recruitment, contribution, and retention. Gender is an important lens, as are others related to age, race, and ethnicity. Organizations that prioritize diverse participation in physician governance across and within service lines, specialties, and demographics are more likely to make better decisions as well as successfully implement those decisions.

Building capacity to execute and sustain

To fully capitalize on the benefits of improved shared expectations and just representation, organizations should carefully evaluate the infrastructure and ongoing resourcing needed to continuously foster physician engagement. While there is no one-size-fits-all approach to capacity building, which involves a broad array of processes and activities including resource allocation, leadership development, communication strategies, and leadership outreach, certain elements are critical for any organization attempting to change from its current status quo.

One recent success story in this regard comes from Dr. Anne Pendo at Intermountain Healthcare. To improve physician engagement and input and reduce burnout, Dr. Pendo established a 30-minute twice-weekly call with her medical directors to discuss upcoming decisions, seek feedback, and provide outcomes of recent decisions. Medical directors were in turn tasked with conducting similar meetings each week with the physicians in their service line. Throughout the process, Dr. Pendo noted that many medical directors grew in their ability to lead, solicit input, and respond to concerns. Physicians at Intermountain also became more engaged and, as measured by their annual physician engagement survey, were more positive about their involvement each year. Rates of physician burnout also significantly declined over this same period.

Reasons for optimism

The optimism Dr. Lee expressed in his NEJM article is meaningful and promising. Health systems are actively redesigning the ways they deliver care to do what is best for patients during this time of crisis. Physicians need to be at the forefront of this reshaping, as they are leading the care teams that deliver compassionate care. Although health systems have long known the value of creating greater administrator–physician alignment through shared expectations, just representation, and investments in capacity, the current moment provides a unique opportunity for them to reevaluate and redesign their physician governance for the post-pandemic world.

To learn more about this topic, please reach out to the Press Ganey Strategic Consulting team at info@pressganey.com.

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