The term “Governance” will lead some to think of their Board of Directors or the dozens of committees that some organizations have collected over time.
We use Governance more broadly—as the foundation for a focused transformational effort and the engine to sustain performance gains.
Initiative Governance is a critical component to any group of people working together to drive change—it nurtures or reshapes the culture and ultimately affects how work gets done.
In this context, Governance applies to an enterprise initiative, program, service line, or functional area. And the need for Initiative Governance is growing with new payment models driving integration across groups that, in the past, have individually provided direct care for the patient but have never had to be truly, directly accountable to each other – such as bundled payment programs or patient experience across the care journey.
For illustration purposes, surgical services is a great example of how individual politics and incentives might cause misalignment. Most surgical service lines or OR departments have had a committee structure for years, but leaders commonly acknowledge that surgeons don’t attend, meetings are infrequent, real decisions aren’t made, and the “committee” becomes a forum for turf wars and complaints.
The unintended results can be mounting frustration over inaction and overall distrust. (Click here for a related post on surgical services.)
In order to avoid this frustration, organizations must set up an Initiative Governance structure instead of a committee structure. The difference is governance includes meetings that have a clear agenda aligned with key priorities, a cross-section of leaders that makes decisions, utilization of validated, transparent data, and an equitable approach to holding all parties accountable.
It may seem like common sense—but not common practice because sustainable improvement and cultural change requires investment beyond a recurring calendar hold, dashboard, and an individual manager to run it all.
Here are questions we ask our senior executives and physician leaders to consider:
- Do we have the right people actively involved? Is our governance inclusive of management, physicians, and clinical staff? For physicians, do we have balanced representation of specialties, employed and independent, long-term and new, protagonist and antagonist? Based on strategic priority, do we have a senior executive sponsor that actively and consistently participates?
- Do we have the right structure in place or do we need to refresh it based on the times? Is there an operating structure, charter, and established guiding principles?
- When did we last review the guiding principles? Do our principles inform the policies and procedures? Does everyone know and have access to these? Who on the current committee was directly involved in their development?
- What data analysis have we done to clearly identify our strengths and improvement opportunities? Are we looking at the right measures, and do we know where we should be? Have we walked the committee through this data—is it understood by all and when it isn’t, do we do more socializing through one-on-one discussions?
- Are we using the right metrics to track progress? Are we using data and the policies to make timely, consensus-driven decisions? Or do one-off anecdotes and silo’d views still create bias?
- Are we consistently transparent with the data? Do we break down this information by physician, service line or functional area to drive accountability?
- Do we prompt immediate operational implementation? Do we have sub-committees in place to create focus in key areas and empower bottom-up continuous improvement?
- Do we position formal and informal change leaders? Do we equip them with data and change management tools to know when and how to lead productive peer-to-peer conversations?
- What is our communication plan for goals, actions, and progress—for our committee, the broader service line or organization, physicians and staff, and related executive committees?
Lastly, when we invest in this type of governance and it works as intended…
- Is senior leadership ready and aligned to address opportunities and barriers that are raised? Are they willing to empower this governance structure to make decisions?