Understandably, medical directors usually focus on patients, families, and their interdisciplinary teams. Much of their time is spent on ensuring quality care, addressing problems, and working with community-based attending physicians. Issues related to a facility's board of directors can fall low on the list of priorities—until this era of culture change. Knowing how board members think and operate can make it easier to work with these individuals and avoid misunderstandings and headaches. David Green, retired president and chief executive officer of Evergreen Retirement Community in Washington state, shared his experiences with culture change at the American Association of Homes and Services for the Aging annual meeting in Washington. He spoke specifically on how boards can help or hinder that change. Mr. Green said making a culture change is like making a career move across country. “You need lots of preparation, a strong support base, and total commitment to it. Everyone involved—including the board—needs to understand that things may get worse before they get better and the journey ends.” For example, he said when his organization underwent change, it had a 20% jump in turnover at first. This figure has declined over time and remained low, he said, but an unsupportive or uninformed board could panic after an increase in turnover and halt change before it can create a positive result. It is important that support of the change be an ongoing part of leadership commitment, even when the board has turnover. “The goal needs to be to sustain the new culture through leadership changes,” Mr. Green said. For this to happen, he said, there need to be core values that emanate from the organization's founding rationale; and the changes need to be harmonious with these values. The thing that makes the founding rationale and values special is the fact that the “founders knew the organization's needs, and these need to be considered in perpetuity,” Mr. Green noted. The board needs to embrace and adhere to these values so the organization's responses will be consistent long after the founders are gone. “The board members are the value guardians of the organization,” he said. Qualities of an Effective Board The concept of accountability is important for a board that will support and respond to change. “When the board recognizes accountability to moral actions, it will have stability. The board focus then becomes constant despite changes in membership,” Mr. Green said. He emphasized that the board members “must suppress their personal interests and values and support those of the organization when they are representing the organization. For example, a “pro-choice” individual would have to suppress those views on the job as a member of a Catholic hospital. Over time, board members consistently must be future focused, “big picture” thinkers. “Consistency of direction is essential for sustainable organizational culture,” Mr. Green said. At the same time, board members “need to know the boundaries within which they must operate.” Knowing the Board The medical director should have a strong—but not a personal relationship—with board members. “Board members may call you on occasion regarding medical issues or questions. However, it is not a good idea for you to be their personal physician,” said Dr. Monte Levinson, CMD. He added that good relationships begin and perpetuate with knowledge and honesty. “It can be very gratifying when board members turn to you for advice, but you had better be prepared. These are successful, accomplished people. You need to have the facts, figures, and timely information. Be honest and informed, and do your homework,” he said. The best way to have a good relationship with board members is to show them that you “have a mastery of your job. Then they will have confidence in you, and they will take you into their confidence,” Dr Levinson said. There are other things the medical director should know about his or her board. For example, is it an “inside” or “outside” board? Small facilities usually have an inside board, which is composed of trusted relatives, friends, and other contacts. Larger facilities have an outside board, which includes individuals who are recruited based on their skills. A new medical director must get to know his or her facility's board members and learn what skills they bring to the table. It's also good to know what contributions board members have made, what programs or ideas they have supported or opposed, and what vision they have for the organization's future. Of course, the medical director can't control how the organization functions at the CEO or board level. But the medical director's job may be easier if he or she understands how the facility works in the executive offices. That information can tell the medical director a great deal about how smooth—or bumpy—the road to change is likely to be.
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Mar 24, 2007
F George 
Open Access
