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Governance starts with principles, not policies

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In healthcare, when we think about governance structures, the first thought that comes to mind are Administrators and the Board of Directors. But if you really understand healthcare and healthcare providers, you understand that top-down directives are not popular with either the medical staff or hospital staff - particularly concerning how their jobs are performed and the guidelines they follow to deliver excellent patient care. Instead, these stakeholders tend to respond better when their peers are delivering the message, such as we see in peer review processes.

In order to build this type of environment, inclusiveness must be a guiding principle; hospitals must build or restructure governing bodies with a composition that includes administration, staff and physicians. For example, let's say your organization has issues with release times for the OR block schedule. If an administrator tells Surgeon A that he or she must release their block a week in advance, Surgeon A will come up with multiple excuses as to why this release time will not work - including the fact that the administrator is not a doctor and does not understand how his specialty works, in addition to how special his practice really is! Now, if another Surgeon were to communicate the same message and explain the premise for the change, it is much more likely that Surgeon A will agree to the change. Indeed, we are socially more inclined to accept and be flexible to 'change' when we are approached by our colleagues whom have an understanding of our work and the variables involved. Essentially, inclusiveness is the key behind building policies with principles. To achieve success in virtually any area, organizations need a cohesive governance structure where administration, management, staff and physicians decide together on what the right direction and approach should be, whether it be for the OR, for a center of excellence, or for the broader system.

I have been involved in helping many organizations set up governance structures like these, particularly in the OR, and I've seen consistent success in achieving sustainable results. Once the right structure is in place in an OR, problems that were intractable become manageable: improving room turn-around-time, holding teams accountable for on time starts and on time arrivals, re-allocating block time, improving pre-surgical documentation, and the list continues. Helping clients through this process requires just the right combination of principles of collaboration, communication, and commitment - and a little magic doesn't hurt!

With that in mind, here are a few key things to consider as you think about Perioperative governance:

  1.  What are the stated principles of this department? (These should precede and inform the policies and procedures).
  2. When was the last time we reviewed those principles? How many of the committee members were in position when that was last done?
  3. Do we have the right committees in place and the right structure for those committees?
  4. Do we have the right members on the committee? For example, is every specialty represented on the Block Committee and/or OR Governance Committee; is the chair an unbiased individual that commands respect; is there a mix of high volume vs. low volume surgeons and supporting vs. non-supporting surgeons and block vs. non-block surgeons?
  5. Is leadership ready to address the challenges raised by these committees?
  6. Are the committees tracking the right metrics and utilizing that information to make data-driven decisions?

In summary, I advocate that before attempting to tackle strategic or operational improvement, first take a hard look at your governance structure to ensure it has the right members, with the ability to make good decisions and implement sustainable change based on their decisions. Governance starts with principles, not policies.

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