Use Secret Ballots to Improve Decision Making

Secret BallotWhen the members of a medical group meet (at either Shareholders or Board meetings) they typically deal with issues that require a decision. Unfortunately, voting doesn’t work very well in many medical groups for the following reasons:

  1. Some group members feel the idea of actually voting is too “formal.”
  2. Some groups think they have consensus because no one speaks up (or only a few speak up and the thought is the rest are willing to go along) – these groups are fooling themselves because when people don’t speak up it typically means they disagree. In addition – if you think you have consensus, why not vote to make sure you do?
  3. Physicians tend to be conflict avoiders. Sometimes discussions go on and on because people don’t want to raise their hands to vote and possibly enter into conflict with those that don’t agree with them. This can make meetings last much longer than they need to.

In my opinion, it’s best to formally vote on issues to make sure the group has the needed majority or super-majority vote. This assumes that the group has gone through a process where the group members agree to support group decisions.

To deal with conflict avoidance, I am seeing more and more groups move to using “secret ballots” for their voting process. Most groups use secret ballots for electing their Board and officers, but some groups use them when they need to vote on controversial issues, or in some cases, all issues.

Why are secret ballots useful?

  • They allow the individuals to “vote their conscience” with less fear of retribution.
  • They avoid one physician “bullying” another physician into changing their vote.
  • They often speed up a meeting because people don’t delay voting to put off conflict.

There are several ways to implement secret ballots – here are two:

  1. Use 3 x 5 cards as the secret ballots.
  2. I have observed some groups starting to use “audience response systems” such as those produced by Turning Technologies (I have no relationship with that firm) – I spoke with a medical group President at a recent conference who’s group had moved to using such a voting system for all issues. He said they had cut about 25% off the time of every meeting by using the system.

Groups that use secret ballot for all their issues have told me that there is only one potentially negative outcome – that people will push too quickly for a vote. Therefore, it is up to the Meeting Manager to make sure that the group has had a full discussion of the issue prior to voting.


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

Will Latham

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