Overcoming the “Dirty Little Secret” – Part 1

Secret 1 - shutterstock_101127469Effective group governance is now a survival skill for medical groups.

Unfortunately, many medical groups, both large and small, suffer from something I call the “Dirty Little Secret.”

Here’s how it goes:

An individual physician thinks: “If I don’t like a group decision, or I didn’t vote for the decision, I don’t have to abide by it or support it.”

Of course, no one really comes right out and says this, but that is often the way individual physicians act.

This type of thinking can kill a group. If you have little expectation that the group members will implement group decisions, why spend time making decisions?

What can your group do about this? I believe that every group needs to ask and answer three fundamental questions:

1. How will our group make decisions?
2. What is expected of each physician once a decision has been made?
3. What are a physician’s options if he or she doesn’t like the decision?

Let’s consider each of these in turn.


Question #1: How Will Our Group Make Decisions?

The group members need to agree on a fair and reasonable process to discuss issues and make decisions.

It is reasonable that there be some discussion, and then voting on the issue. It may be that the group will agree to empower a subset (such as a Board) to make certain decisions for the entire group.

However, as I will discuss in later postings, I think it is unreasonable to require unanimity on decisions, and you must be very careful in pursuing consensus (which most people take to mean unanimity). In today’s environment, the group needs to be able to move forward with a majority (or super-majority, depending on the issue) vote.


Question #2: What Is Expected of Each Physician Once a Decision Has Been Made?

What you want to hear includes:

• Do it.
• Abide by it.
• Implement it.
• Support it.
• Not sabotage it.
• Not complain about it to outsiders.

If you don’t hear the group members stating these expectations, or hedging on these items, you will suffer from the “Dirty Little Secret.”


Question #3: What Are a Physician’s Options If He or She Doesn’t Like the Decision

There are three:

1. Do it anyway: That’s group practice. If you want to be in group practice, there will be times when you must support something you may not fully agree with.

2. Try to get the decision changed: But in the right forum (i.e., the Shareholder or Board meeting), and continue to abide by the decision until it is changed.

3. Self-select yourself out of the practice: I know this is a tough one, but each physician should commit to either supporting group decisions or leaving the group. The expectation should be set that a physician will not and should not stay with the group if they won’t abide by group decisions.


In Real Life

A number of years ago I began a strategic planning retreat by asking a group these three fundamental questions. After the group agreed on how they would make decisions, what was expected after a group decision was made, and what were a physician’s options if they did not like the decision, one of the physician said to me: “So, let me get this straight – in today’s meeting, we are going to make some decisions?”

“Yes,” I replied.

He then said “And we are really going to implement the decisions we make?”

“You just agreed to do so,” I replied.

And then he said “well, I guess I am going to have to pay more attention today than I have at any other planning retreat I’ve attended!”

A very telling comment. Prior to agreeing on these questions, he knew that there was no real commitment or expectation that individuals would implement decisions, because the group had never agreed that it would.

The answers to these question form the basis of developing any effective system of group governance.

Please contact me if you’d like to discuss this post.

Will Latham

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