Issue: June 10, 2021
Disclosures: The Wyanoke Group is the parent company of Healio and SLACK Books.
June 01, 2021
5 min read
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Secure more engagement from practice owners

Issue: June 10, 2021
Disclosures: The Wyanoke Group is the parent company of Healio and SLACK Books.
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“The worst thing is to get involved with people who aren’t passionate about what they’re doing.”
– Willem Dafoe

“The difference between involvement and commitment is like ham and eggs. The chicken is involved; the pig is committed.”
– Bennett Cerf

Unlike other kinds of boards — for corporations, let’s say, or foundations — practice boards are composed of members who serve not because of any particular business or institutional skill, wisdom or engagement, but simply because they are owners.

John Pinto
John B. Pinto

A few eye surgeons are naturals at practice governance. They prepare for meetings in advance, arrive on time, speak up freely and eventually compete for the role of managing partner.

A few other ophthalmologists, although they contribute in financial terms and even as clinical thought leaders, shrink from their responsibility as fellow business owners. They are slow to return business-related emails, they skip board meetings, or when they do come, they read their cell phone at the far end of the table.

The majority of practice owners fall between these extremes. They engage when encouraged, but if allowed, they will just as easily sit on the sidelines. This month’s column is written for these incompletely engaged owners — and the administrators and managing partners who are trying to get them more engaged with the company’s affairs. Here are six ways to help blasé owners get more involved and interested in your common practice.

1. Start early. New board members should be oriented to the financial and volume performance of the company and should gain a memorized understanding of the practice’s chief metrics (things such as profit margin, labor productivity stats, growth rates and the like). They should periodically reread the practice’s operating, shareholder and employment agreements. Of course, in reading this, you may recognize that you have some catching up to do, not only with the most recent doctor to make partner, but with the entire board.

2. As the managing partner, make your expectations clear. Here are some concrete examples of the expectations you can request:

  1. Show up: “We hold 12 board meetings a year, and I expect you to miss no more than two of them.”
  2. Be prepared: “We have an agenda and board package available 72 hours before every meeting. Please take the time to review these materials, just as you review a patient’s chart before surgery.”
  3. Speak up and listen up: “As managing partner, I will do my best to assure that everyone’s voice around the table is heard. You can help me by not dominating the discussion and by encouraging others to speak.”
  4. Volunteer: “Our practice will perform best if every owner takes on a project or two every year. Step up.”
  5. Vote: “During the average board meeting, we make five formal votes. Remember to ‘vote your fiduciary,’ which is to say, what is best for the company, not yourself. And if the majority vote goes against your preference, be sure to support the vote publicly when the meeting is over.”

3. It is hard for an owner to get engaged with their company if they do not have an understanding of — and a degree of emotional attachment to — the practice’s long-term strategic destiny. This does not require a 50-page business plan (although that would be nice). Instead, discuss and decide as a group on the answers to the following questions:

  1. What is our planning horizon? (Are we barely treading water and can only think about the next few months, or are we a stable firm that should be thinking a decade or longer into the future?)
  2. What is our service area? (The north/south/east/west boundaries from within which a majority of our patients are derived.)
  3. What is our service mix? (What services should we add or subtract in the years ahead?)
  4. What is our provider mix? (What ratio of MDs/DOs and ODs should we employ?)
  5. What is our desired growth rate? (Do we want to just keep up with slowly growing demands in our community or grow our market share?)
  6. What is our succession plan? (Will we pursue the traditional admission of partner-track doctors, align ourselves with a local health care system or explore a private equity partnership?)

4. Become a more dynamic, engaged managing partner (or administrator). Engagement is catching. If you are the MD-peer or lay leader of the practice, you ultimately set the tone. Some of this is raw time and availability. Some involves a bit of Dale Carnegie showmanship. Few are born with these skills. Everyone can learn them. Channel your inner cheerleader.

5. Make board meetings more interesting and appealing. Some of this is purely atmospherics. Who can stay awake or think their best thoughts in a windowless after-hours repurposed staff lounge? After a full-day’s clinic or surgery? Schedule meetings for a time when owners are sharp, even if it requires a few weekend hours monthly. Many practices find the easiest way to spark up meetings is to hold dinner board sessions in private rooms and to rotate the location to keep things interesting. Beyond this, there are dozens of ways to make meetings more lively: guest speakers, choosing a business problem and breaking into two competing teams with a prize for the winner, a longer focused discussion if the topic requires or a rapid-fire shoot-out with a timer if there are a number of small items to clear from the agenda. Take field trips to other practices or settings from which you can become more inspired.

6. Perhaps most importantly, you can only get fellow owners engaged if you give them something to engage with. Let’s say you have a colleague, Sam, who rarely speaks up or gets involved. But he is really sharp at statistics and is a stickler for quality. Make him the head of your new quality assurance committee and assign his committee with a first project: measuring the practice’s cataract surgery outcomes.

Remember that getting your fellow owners and board members more engaged is just the start of great governance. Effective governance requires that the organization has a consistent mission, which is written down and referred to often. It requires formal written agreements among the owners about how the practice’s business will be conducted — and someone making sure these agreements are adhered to. And it requires a balance around the table of both good leadership and good followership, a willingness to be led.