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Sorting Out a Governance Process for Clinical Decision-Making: The 7 Truths

06/21/19

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Deborah Roy, Principal, Clinical Advisory Solutions

Whether an organization calls it governance or refers to it as oversight, leaves it to a steering committee or keeps it within a traditional value analysis structure, the goal is the same: create an informed, clinically driven process at the physician level for patient-centric decisions that are implemented at the organizational level. Or in some cases not implemented.

The core impetus for any governance structure is ensuring your organization achieves its fullest potential in delivering quality patient care. Anything short of that is unacceptable. So why is this so difficult to achieve and sustain? Why do so many organizations fail to understand how and why their physicians make decisions and which basic procedural tenets lead to success and sustainability?

The first truth of a governance process is that there is no standard process – a difficult concept to grasp for organizations seeking a best practice- or a “Governance for Dummies” approach. Governance is all about culture and relationships. It can’t be embedded into software or the latest technology platform. It requires an understanding of the organization’s past and present and marrying the two to create a strategic vision. Once this vision comes into focus, it will become obvious that there won’t be anything standard in your governance structure except this: an organization-wide understanding that physicians are the linchpin to quality of care and outcomes.

As you build your governance structure, keep in mind each level will vary; at the same time, each level should reflect the organization’s mission. At a very minimum, a decision must be made as to what you’re trying to govern. Is it cost, quality, data or a combination of all three? What you choose should relate to your organization’s purpose.

Strategic visions, the second truth, are, generally speaking, broad definitions of the ultimate purpose of the care to be provided within a health care system. Often the physicians’ visions and goals don’t reflect those defined by the board or administration. A combined vision allows for efficiencies, the proper use of resources and the ability to provide patient care superior to the competition.

In the struggle to put some type of governance in place, physicians often ask for the third truth: more transparency. Transparency of data allows for informed decision-making. If you’re not already on a regular cadence of sharing cost and quality data within your organization, this is step one to any thought of engaging your physicians. You must define what it means to your organization because it may mean something different even within a department, a service line or a committee. Is it the governance structure itself that should be transparent? Or is it data, financials, clinical evidence, administrative involvement, etc.? Once it’s defined, you can begin to strategize how to move toward better patient quality outcomes, typically followed by a reduction in cost.

Transparency and strategic communication, the fourth truth, are often referred to in the same dialogue among physicians. Guidelines for consistent, active and actionable communication are a challenge in just about every organization. Communication isn’t only about providing information but also about understanding how it’s received and if it’s affecting the audience as intended. It’s critical to know the best method to reach the most physicians and ultimately understanding whether your messaging makes a lasting impact that connects to the strategic vision.

Still, no matter how ideas, policies and strategies are communicated, there’s always room for debate, the fifth truth. If physicians have one thing in common, it’s that they are all aware of their own patient outcomes and what it takes to manage and grow their reputation in their area of expertise. To sustain that level of competition and patient care, accept that your physicians will come to any discussion armed with what they believe to be the best course of action. This should not be seen as a negative. Embrace their engagement and be prepared with a structured agenda to lead them to a decision that will be supported by the organization and accepted by the majority. Ask and allow good questions that can further the discussion and put parameters in place to ensure accountability.

Governance is not easy and like anything of value, it comes with a cost. But what that “cost” includes will be unique to your organization. To foster long-term engagement, that “cost” needs to be part of the initial process planning. For instance, alignment may come from employed physicians, and it may not. Either way, a clear understanding of cultural alignment is critical. Smart organizations know they need to start with identifying inefficiencies from their physicians’ perspectives that affect the best possible care for their patients. Leaders will address these operational issues and make every effort to be proactive and communicate appropriately. The fewer operational inefficiencies – the better the alignment, which then leads to engagement in the governance process.

Alignment need not always be financial in nature, but when it is, approval from key financial stakeholders needs to be part of the process. A policy that’s imparted by finance, but physician led and driven, can provide a platform for a percentage of savings to be reinvested into the patient care needs of the organization.

The final truth about the role of governance is that it’s never static. With the ever-changing nature of health care, it takes time, commitment and regular review. A culture allowing for respect and freedom of opinion is the cornerstone of a good governance structure, and it’s achieved only through constant rigor that captures the interests of your physicians with a singular goal of providing excellent outcomes to your patient community.

About the author. With more than 30 years of experience in the health care industry, Deborah Roy has held numerous leadership roles responsible for the creation, development and measurement of value analysis teams, consistently exceeding targeted savings projections. In her role as principal at Vizient, Roy leads efforts to assist our members in achieving best practice protocols for service line improvement across all clinical operations, as well as leading interdisciplinary teams in the development of customized approaches for product and new technology selection.

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