2. The intent of this session is to review the key tenets for designing effective decision making structures and accountability systems to meet the demands of the integrated practice.
3. Agenda Governance 101: Overview the structure and principles relevant to physician practices Implications of integrated models Relationship between Governance and Physician Compact Physician Compact 101: Overview of structure and principals Relevance of Physician Compact in integrated models
5. Governance “No one ever teaches well who wants to teach, or governs well who wants to govern.” Plato
6. Governance A formal/legal structure for setting and implementing strategy A system to make informed decisions Leadership Creation and communication of Vision A means of developing consensus, collaboration, and alignment A system designed to achieve RESULTS/OUTCOMES
7. Governance Equation Board Composition Governance Performance And Contributions Board Structure Board Functioning Board Infrastructure Effectiveness = Doing the “right” things Efficiency = Doing things “right” Source: Dennis D. Pointer 1998
9. Shareholders Own the practice Maintain a few “reserve powers” Elect the Board of Directors In smaller groups, all shareholders may be on the Board
10. Board of Directors Accountable to the shareholders Maintains/delegates all corporate power (except for reserve powers) Strategic not operational focus Manages practice through a CEO Empowered by the shareholders to act
11. CEO The bridge between the strategy function of the Board and the implementation function of management Accountable for implementation of the Annual Business Plan and Budget Empowered by the Board to act
14. From Private Practice to Integrated Physician shareholders to hospital stakeholders Composition of board changes Strategic imperatives change Environment changes: Enterprise with diverse set of objectives More complex operations
37. Cement the Foundation Provides clarity to the “give” and “get” to physician practices It clarifies these issues in writing Useful to maintain/create culture Useful to recruit successfully, managing expectations
38. What is a Physician Compact? It is the unwritten, shared understanding of what physicians and their practices owe one another In industry… Work hard, and you will be rewarded with long term employment Great retirement, health care….. Global economy changed that
39. In Health Care… What do you give in return for what you get…historically, it has meant: Autonomy – care of patients without interference Protection – from hassles of running the business, from market forces Entitlement – yearly increases, increased support staff regardless of how treat staff or other colleagues Call schedule It gets at the culture of the practice
41. When is a Physician Compact Useful? When market conditions change Group size is increasing Physicians desire for family life Need to change geographic coverage areas Address behavioral problems Improve access Make technology decisions Increase productivity Develop and/or adhere to practice guidelines Merger, acquisition, partnership
42. Changing the Covenant – Two Approaches Chip away at perceived compact This widens the gap between group expectations and reality Reshape through a facilitated, overt, organized formal process Leadership and physician driven Clarify what is working and not working Clarify how the market conditions have changed Visit the “give” and “get” expectations Clarify new expectations that will promote the success of the practice Implement – making changes to the by-laws if necessary
43. Philosophical vs. Political “I believe in political solutions to political problems, but man’s primary problems aren’t political, they’re philosophical. Until humans can solve their philosophical problems, they’re condemned to solve their political problems over and over and over again. It is a cruel, repetitious bore.” Tom Robbins, Even Cowgirls Get The Blues
44. Four Categories Leadership Work environment Practice development and long term security Quality patient care and clinical excellence
50. Practice Development and Long Term Security Physician Responsibilities Leadership Responsibilities Maintain respectful communication with patients, referring, and ER physicians Support the development and adoption of appropriate new therapies and technologies Participate and support non-clinical activities essential to the group’s success (recruiting, meetings, committees, public speaking) Prepare for the future through effective recruiting Facilitate a competitive income level quality of life Establish and maintain a sustainable retirement policy
51. Quality Patient Care and Clinical Excellence Physician Responsibilities Leadership Responsibilities Practice evidence and guideline based medicine Respect that your partners are using their best judgment Support internal and external CME opportunities when appropriate Support the research program Maintain board certification in cardiology Support outpatient lab accreditation Support physician education efforts for technologies new to the practice Provide patient and referral physician satisfaction surveys Maintain a quality initiative in the practice
53. How Can You Use Your Compact? As a reference and reminder when problems arise As a tool for setting expectations for new hires As a guide to further expand upon to address reoccurring issues
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56. Incentive Example – 35 Cardiologists $5 incentive per RWU Quality and efficiency Compact objectives
57. Compact Summary Clarify expectations Document expectations Evaluate Provide feedback Create action plan
58. Integration vs. Alignment Integration: predominant delivery model Integration is not alignment Integration: negotiation, structure, finance Alignment: cultural, behavioral, outcomes Integration is the means to the alignment end
