Depending on how well they are organized, board meetings can provide vital monthly or quarterly face-to-face time among the decision-makers to keep your physician practice running smoothly. Or they can devolve into a cat rodeo—a huge waste of time and energy where very well-educated, opinionated, highly trained professionals find themselves arguing over the everyday and trivial issues that should be solved on the middle-management level.
At Radiological Associates of Sacramento (RAS), the monthly practice board meeting is a model of efficiency. It is no small feat to get the 64 physician owners of the practice to sit down for two- to four-and-a-half hours every month to review critical governance issues. But the efficiencies built into the meetings, which might seem effortless to the casual observer, are actually the result of constant streamlining and review, says Fred Gaschen, executive vice president at RAS.
"I'm proud of the way they have organized this," Gaschen says. "I've been here more than 13 years, and I inherited a good structure. But I'd like to think that in that time, we have streamlined and improved the structure."
RAS has been around since 1917, and Gaschen says the physicians in the practice know enough to let the business people they've hired to run the business, run the business. The business side takes care of the minutia and helps the physicians organize the subcommittee and board meetings.
"We support the decision-making process by the physicians at the board level through our infrastructure," Gaschen says.
This all seems perfectly logical and simple: Don't waste everybody's time squabbling for hours about lower-level management issues that prolong meetings, force you to skim through more important issues, and leave practice partners irritated by the sense that important issues are not being addressed. But it's surprising how many physician practices run their meetings exactly that way, says Kenneth T. Hertz, CMPE, principal consultant at the Medical Group Management Association Health Care Consulting Group in Alexandria, LA.
What's on the agenda?
"I don't think you want to spend a half hour at a board meeting deciding what kind of chairs you are going to put in the reception area. I don't think you want to spend a half hour at the board meeting or partner meeting deciding whether Dr. Jones' nurse Mary should get a bigger raise than the other nurses because she has been here longer and, after all, she does three times the work everybody else does," Hertz says.
Instead, he says, the board should focus on governance. "We are talking about strategic issues—mergers, acquisitions, integration, recruitment, strategic decisions to develop a marketing plan," Hertz says. "Sitting at the board meeting is not where you read the copy for the ads and Dr. Jones says, ‘I don't like the way that paragraph is written.' It is your right to question, but there are certain things you need to entrust to a manager or a subcommittee."
To run an efficient meeting, Gaschen says, what is not on the agenda is almost as important as what is on the agenda.
"Small operational issues are not discussed at the board level. The board is responsible for overseeing the corporation setting policy and directions. That is their role," he says. "The day-to-day operations are handled by the respective administrative staff hired in each division. "
For example, RAS has several subcommittees that meet weekly to vet and prepare issues for the larger board to act upon.
"It is at the divisional level they will look at new offices, new equipment, new services, or new medical ways of doing things, and there will be a lot more debate at the division level and the subgroupings that happen between the monthly board meetings," Gaschen says. "So the division will arrive at a consensus within its membership and that division will take it forward to the executive committee for informational purposes and the board of directors for final approval.
By the time it gets to the board of directors, it has been vetted in multiple stages along the way. Rarely do we bring something up to the board level and there is a big brouhaha."
Meeting parameters
The agenda, the structure, the frequency, and length of the meeting may vary from practice to practice, depending on what works for the practice, Hertz says, but there are also some fundamental commonsense rules that should apply, regardless of whether you've got two or 200 physicians in your practice. For example:
"Meetings need to start and end on time," Hertz says. "The people who show up on time shouldn't be penalized for the people who don't. It's disrespectful not to start on time and end on time. The more you don't start on time, the more people say, ‘Why should I show up on time?' and then it becomes a downward spiral."
Meetings need to have a structured agenda and a facilitator to ensure that the agenda advances. "What we really want is the meeting to move forward. I've sat through many meetings where nobody moves. Somebody introduces a topic and it just meanders. There has to be some leadership," Hertz says.
In most physician practices, the president of the board or a managing partner should lead the meeting. "I've seen a lot of practices where the administrator or manager chairs the meeting, but I'm not a big fan of that," Hertz says. "They are an employee. It's your practice. You're the governance. The manager can meet with the chair or the president, re- view the agenda and the material, point out any land mines or other things they need to be aware of, but, ultimately, a board needs to do the board's work."
Physicians need time to prepare for the meeting. Hertz says one of the most common complaints he hears from physicians is that they aren't given a chance to plan for the meeting. He recommends publishing agendas as far in advance as possible.
"You come to the meeting and somebody gives you a 15-page report and expects you to comment on it. That is not right," Hertz says. "I also hear, ‘I came to the meeting and all I heard was reports and I left.' Well then, why have a meeting? Put it in writing and e-mail it to me."
Hertz says some practices don't issue the agenda because they say their physicians won't bother to read it. "I say, ‘I don't really care.' The right thing to do is give it to the docs in advance and they read it or they don't. It's their choice, but that is the proper way to do it."
Don't rehash the same issue in meeting after meeting. "Some practices allow that. Some practices say, ‘We made the decision. We are moving on.' If it is a major decision that the board is going to make and the board isn't made up of all the partners in the group, it is incumbent on the part of the board to get the shareholders' input before the meeting and before the decision is made." In the end, the board can't allow itself to get bogged down on one issue. Make a decision. It all comes back to leadership.
This story first appeared in an edition of The Doctor's Office, a HealthLeaders Media publication.