its agility and capacity for
responding to needs and making
decisions quickly. Additionally, committees were
restructured and formalized.
Springer said that today’s committees of the
Intermountain Medical Group board are aligned
around each of Intermountain’s fundamentals
of extraordinary care and top priorities, and all
medical group physicians and APPs are invited
to nominate themselves or others as committee
members. The committees function to give voice
to frontline clinicians and enhance their engagement in governance. Committee members are
able to generate ideas and solutions and then
recommend these changes to the board, while
the board’s decision-making role gives this smaller group final
voting power. These structures and functions are outlined in
the board’s current bylaws.
The last part of the new framework involved establishing a
formal mechanism for communication, enabling information
from the front lines to flow successfully to a point of authority
such as a management team or committee. A matrix was even
constructed for better transparency, so that clinicians know
where decisions are being made and what’s in the queue of
priorities and progress.
“Leadership is critical,” notes Mark Briesacher. “It is not lost
on me, and I would be remiss in not emphasizing the tremendous leadership in governance that our board of 30 provided
as they designed, debated, and approved new bylaws. These
leaders fully embraced their fiduciary responsibility to the
Intermountain Medical Group and Intermountain Healthcare.
They have created a governance structure that best serves
our patients, our physicians, and advanced practice providers,
and all of the caregivers of the Intermountain Medical Group.”
The Impact of New Governance
The impact of Intermountain’s new governance structure took
little time to surface. The number and quality of decisions
board members have passed has improved, simply from the
group no longer getting lost in the details of implementation.
Milligan said, “We’ve had to increase the time that we spend
as a board together and decrease the number of agenda
items just to accommodate the depth of discussion that
we’re having on some of these issues.”
The board is doing a better job of fulfilling its oversight
responsibility. It created a dashboard to keep track of its
decisions and the progress and outcomes as those decisions
are implemented. Further, the implementation of decisions
shows they are more meaningful.
An example of this is the role the new board is playing in the
design of new compensation models. Primary care compen-
sation needed to be reviewed to align with Intermountain
Healthcare’s new organizational structure and operating model,
which has increased focus on value-based care
and population health. While trying to anticipate
possible pitfalls, the stewardship and compen-
sation committee of the medical group board
established this as a key strategy, shared the
needs of providers, asked key questions about
goals and practical delivery, and supported
management in designing a revised compen-
sation model that aligned with Intermountain’s
principles and physician initiatives.
Recently celebrating the one-year anniver-
sary of the new board structure, Intermountain
is continuing to look forward, examining what
governance should be, particularly regarding
representation and diversity. Intermountain is
now intentionally tracking these markers of perspective, not
just across gender and race, but competency, experience, and
geography. In addition, more than 85% of its voting members
are now frontline clinicians (see Table 1 and Figure 1).
Looking back, Intermountain came away from their experience with several key takeaways.
“Number one, if you’re going to make a change, define what
you are wanting to achieve so you can measure it beforehand
and measure it after,” Springer said. “And make sure it is
actually doing what you think it should be doing.
“Two, board structure absolutely dictates your governance.
If you want good governance, you have to create the structure
to support it. You need to create those defining, guiding principles and then develop that framework and structure so you
can be successful in that area.
“Number three, I don’t think you can ever over-communicate.
Maybe you have figured that all out with your physicians,
but I think consistent communication of what we are doing,
addressing that ‘why’ and personal connection, is essential in
making any change with our group.
“And lastly, and most importantly, I think we as leaders need
to be intentional about listening to our frontline physicians
and APPs. There is a lot of wisdom in our frontline clinicians.
We need to tap into that to be successful. We need to engage
them. We need to involve them at a better and even higher
level so that we can make sure that we can be successful
Mark Briesacher, M.D., is senior vice president and chief physician
executive, Intermountain Healthcare. He also serves on AMGA’s
Board of Directors. Karyn Springer, M.D., is chair, Intermountain
Medical Group Board, and trustee of the Intermountain Healthcare
Board of Trustees, which is made up of community leaders as well
as Intermountain leaders and ensures the organization as a whole
aligns with community needs. Mark Milligan, M.D., is chair, Nominating and Governance Committee, and member, Intermountain
Medical Group Board.
medical groups and
health systems will
be presenting at the
AMGA 2020 Annual
25–28 in San Diego,
California. For more
details, visit amga.