Professional Interaction – Best Practices Series
Governance: Getting Cooperation from Partners for Decisions
By Fred Corbus
This article first appeared in Round-up Magazine, official publication of the Maricopa County Medical Society.
This is the second in a series of articles explaining 10 Best Practices for Professional Interactions:
• Why you want Best Practices
• How you can develop them
What is Governance?
First of all, here is what I mean by “Governance”:
Typical Governance Grief
During my past 28 years serving clients, I have seen and heard a lot of bad stuff surrounding governance such as: “There’s never any excitement or even agreement around here about our decisions. In fact, our decisions are either sabotaged or DOA.”
I often find many of the following:
- People who resent the decision makers
- Decision makers who are frustrated because they don’t feel supported
- Decision makers who run “amok”
- Wasted energy and resources as a result of chasing competing decisions
- Quiet turf wars (that sometimes become very noisy)
- Medical directors and managing partners unnecessarily afraid of giving up “power”
- Great opportunities and the fun of moving ahead missed
Why You Don’t Already Have a Governance Document
Here is your problem: you just want to practice medicine and/or carry out your management/leadership role. The forces that allow you to ignore addressing the above-mentioned undercurrents are powerful, and understandably so. I suffer from these same forces in my own firm. But, I can promise you that hitting them head on could be the best thing that ever happened to you. Those undercurrents can be reversed! In the last article, I mentioned that each Best Practice should have a simple “document,” the product of well-directed open discussion, and one that is personal, succinct, hard hitting, and ready for future reference.
What a Governance Document Looks Like
Let’s start with two examples of a Governance Document (although every group, every setting, every organizational structure has a different document unique to the types of decisions and people or entities making those decisions). This first example is a small group with a loose organizational structure – all kinds of people doing what is necessary to keep the practice going. Formality is not needed, but there is a need to agree on a simple list of decisions that require a majority or a consensus vote of the partners.
Typical Decisions Requiring a Majority (or Greater) Vote
- Determining admission criteria/patient criteria.
- Adding physicians.
- Hiring physicians.
- Hiring paramedical staff.
- Determining time mix use for physicians.
- Deciding level and types of teaching activities
The second example is typical of governance documents created by faculty departments/programs. (The list would probably have another 15 – 20 items.)
Having spent many hours facilitating meetings, I’m the first one to recognize that decisions and the delegation of authority are seldom cut and dried! You will notice that this example includes “Level of Delegation,” which allows a sliding scale for assigning authority. Is it most appropriate for someone to just do the work, but come back to the group for a vote? Assign that person a Level 1. Or, is it most appropriate for that person to do the whole ball of wax? Assign him or her a Level 3.
Decision-making body & areas of responsibility |
Level of delegation |
Committee
chair person |
Members |
Meeting frequency |
|
|
|
|
|
1. Academic affairs committee |
|
Assistant Director |
Faculty physician |
Twice a month |
|
|
|
|
|
• Curriculum |
3 |
|
Psychologist |
1 ½ hours |
• Medical students |
3 |
|
Residency coordinator |
1st and 3rd Thursday |
• Recruitment |
3 |
|
Chief resident |
7:30 – 9:00 am |
• Residents |
3 |
|
3rd-year resident representative |
|
Levels of Delegation
Level 1 – Provide preferred and alternative solutions/decisions.
Level 2 – Implement preferred solutions/decisions, and report back to the group periodically.
Level 3 – Implement preferred solutions/decisions, with no need to report to the group.
How to Develop a Governance Document
First, you have to know what you are going to create as a document. The above examples are good ones for handing out at a meeting and getting started. Now for the meeting process: in many cases, the need for a governance document arises out of an issue (somebody made an unpopular decision, or decisions are not being made, or two people believe they should be making the same decision). As with most “democratic documents,” everyone involved must be included in the discussion to insure buy-in.
Typically, first list the decision topic, then assign the decision-making body or person, then assign the appropriate level of delegation last. If everyone is in attendance, everyone has been heard, and good honest facilitation has allowed input, you have a Governance Document.
“The development of documents such as these is an investment of time; requiring meetings where participants listen and understand. Giving a joyful environment within which to practice medicine makes it all worthwhile!”
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