Achieving a Governance Structure to Drive Success

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As we all strive to achieve the Quadruple Aim in delivering high-value patient care, it is imperative for health systems to integrate physicians into the leadership of services, programs and disease-state centers in an impactful way. This integration will help improve the health of the population, patient and family experience, and life of health care providers and staff as we work in parallel to reduce health care's per capita cost.

The integration of physicians into the co-management of departments and programs has evolved from the traditional model of having physician medical directors – selected from both independent practice and employed groups – contracted to provide the hospital with clinical leadership in a vertically siloed departmental model for managing operations and governance.

These medical director arrangements focus on deliverables tied to quality and patient safety, clinical outcomes, and accreditation requirements with provisions to compensate physicians for administrative time and the achievement of predetermined performance metrics of success. Under this model, both the medical director and respective area's hospital management should have aligned metrics of accountability for co-management.

As cardiovascular physicians have transitioned from independent private practice or academia to becoming legally integrated with a health system in the last decade, the scope has grown to include a focus on operational and financial success. As such, the traditional hospital department co-management structures that existed in silo alignment with one another have evolved to a full spectrum service line model around patient types or disease management across the entire continuum of care (ambulatory, inpatient and procedures).

This model lends to the development of a clinically-integrated care model for coordinating care, driving accountability, enhancing organizational focus, empowering the team for improved integrated care, and fostering a culture where shared decision-making and accountability between physicians and hospital administration are paramount to achieving the Quadruple Aim.

A critical success factor of the service line model includes an organized governance structure that incorporates the pairing of physician and administrative leaders (dyad leadership model) at the top of the service line or institute with co-management serving as the foundation of the entire service line model.

The dyad team could include one or a number of cardiac specialty physician leaders (i.e., cardiology, cardiothoracic surgery and cardiac research), nursing leaders and business administrators. The physician leaders serve as the head of the specialty faculty practices in addition to the specialty services provided within the hospital, representing the full continuum of care.

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The leaders – both physician and administrative – are responsible for creating a shared strategic vision; planning and executing strategy; role-modeling leadership and teamwork; engaging service line team members for feedback and input; using and promoting data transparency for improving quality; managing resource talent; implementing operational efficiencies; aligning strategy and compensation; and monitoring performance across the service line spectrum.

Through the service line governance and leadership structure, the physician or administrator dyad team model may be replicated throughout the infrastructure, more specifically to lead subspecialty areas and program operations at the local level or via key councils with the overarching governance leadership having the ultimate authority and organizational accountability for the service line.

In determining the governance and management structure, the responsibilities and process for leader selection must be defined with written job descriptions and deliverables for leaders at all levels, with an understanding of how decision-making occurs in the service line model.

The organization's top dyad leaders may work within an executive committee with the addition of other appointed physician and management disciplines representing the service line. This group meets regularly to evaluate the execution performance of the strategic vision and shared decisions that support the intended goals and initiatives.

In monitoring success of the service line, the governance and leadership body must have knowledge and understanding of program effectiveness and outcomes, as well as agreement on how service line success is defined. They provide oversight using objective data trended month after month in dashboards or scorecards, with a focus on clinical quality, financial, academic and more.

If performance is less than desirable based on trends of the data, leadership must be prepared to correct the course with actionable plans. It is crucial to share data in an organized, systematic fashion through an effective service line dashboard to create a culture of transparency and allow for performance oversight, management and improvement.

The service line governance structure leverages the strengths of each dyad member. The physician will ensure quality of care, promote clinical innovation, monitor provider performance, reduce unnecessary variation in care, ensure good relationships with referral sources, determine quality metrics and champion change for improvement.

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The administrator is responsible for business strategy and growth planning to support the clinical strategy, revenue and operating expense management, efficient operations, capital and facility planning, performance reporting, and facilitation of support services.

An effective dyad partnership relies on open and continuous effective communication, as well as a team-based approach to convey the vision and mission. It also relies on an intentional drive to create a desirable culture, commitment and close oversight to achieve performance, strong management of internal organizational relationships, and collective problem-solving for solutions.

The use of an effective governance model – where decision-making is deliberate and informed by transparent data analytics – provides a framework for developing, implementing and executing an organizational vision and strategy. Moreover, breaking apart the silos of traditional co-management models towards the creation of a strong dyad governance structure will create a governance and leadership structure to achieve the Quadruple Aim.

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This article was authored by Kay Stewart-Huey, vice president at the Children's Healthcare of Atlanta Sibley Heart Center in Atlanta, GA.