In Part I of our post on engaging employed physicians in your hospital's success, we discussed engaging with physicians as business partners. In this post, we explore a successful model for decision-making, performance improvement and accountability.
Two Levels of Operational Governance
Most community hospitals that own multiple medical practices and employ or contract with physicians and other providers will have two levels of operational governance. The most important level occurs at the practice, where “the rubber meets the road.” Practice Operations Councils, or POCs, are site-specific or department-specific councils that include as members all the physicians and other providers, in addition to a well-qualified ambulatory executive—who is usually the practice manager’s boss. As in successful private practices, POCs are responsible for the success of the practice in terms of clinical quality, service quality, provider productivity, and financial viability.
The second level of operational governance for hospitals with multiple medical practices occurs at what we call the group or “network” level. A Network Operations Council, or NOC, deals with network-wide policies, decisions, initiatives, practice performance, and more. Again, an NOC includes selected physician leaders from across the network of practices—selected for their leadership ability. One thing to keep in mind with hospital-owned medical practices is that, because the employed physicians do not capitalize their decisions (as they do in private practice settings), operating councils need to include a representative of the capital partner, which is usually the hospital. So, in addition to involving physician leaders, an NOC also brings on senior hospital executives who can provide the capital to fund the council’s decisions. Network Operations Council membership often includes the hospital CEO and the hospital CFO, who meet with the selected employed physician leaders on a monthly basis to help ensure that the hospital-owned practices support the success of the integrated enterprise.
Why the Council Model Works
As a physician engagement approach, the council model has stood the test of time and circumstance. It simply works! Here’s why: It is a forum for dialogue between physicians, other providers, and executives to improve performance and to solve problems in the practice setting and across integrated networks.
The model enhances physician accountability to support performance improvement at the practice level and increases management’s accountability for successful implementation at the practice and network levels.
To return to the story we began with, once we diagnosed the key barriers to performance improvement, we were able to help our client implement the council model and develop an effective implementation team. Their physicians became engaged in and committed to driving the success of the individual practices and the medical practice network as a whole. Building a forum for collaboration between providers and executives at the practice and network levels made it possible for this integrated organization to experience dramatic improvement in service quality, productivity, and financial viability. This is because, when properly implemented within a supportive management infrastructure, the council model works—every time and everywhere.
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