How much Physician Performance Data should a Board Receive?

Patient Safety Quality Monthly

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March 28, 2007

I recently received the following question: "How much detail on physician performance should go to the Board? It has been my opinion that a Board member cannot make informed decisions unless they see the same detail as physician committees."

While at first glance that may appear to be true, in reality, Boards often make decisions with less detail than the group below them. In fact, when Boards demand the same level of detail, it can actually be diagnostic of organization dysfunction. How can that be?

As an example, let's look at how much detail a Board finance committee requires to make a decision. While there are certainly enough numbers there to appear highly detailed, compared to the detail analyzed by the CFO and the management team, the Board is willing to accept less detail and still make decisions. That is because the Board depends on the credible accountability systems and processes underlying the information and recommendations they receive.

So why does a Board need more detail on physician performance? In my experience, there are at least three reasons:
1) The Board is unaware of the credible process for obtaining physician performance data,
2) There is little data available so the Board feels it needs to look at all of it, or
3) There is data but not a mutually-agreed-upon interpretation, so the Board is not sure of the basis for the recommendations it receives.

Let's look at each situation.

If the medical staff has good systems for measuring physician performance, then the Board needs to be educated. Often this occurs best if there is a Board quality subcommittee that can spend time to understand the process.

If the there is little data available, the solution requires the Board to demand more physician performance data be collected to base recommendations on. If limited data is due to a lack of hospital investment to collect the data, the Board can help the medical staff get the needed resources. If it is due to lack of medical staff willingness to accept the data, the Board needs to push the medical staff to move forward.

If there is a lack of agreement or understanding on how the data should be interpreted, the medical staff needs to set prospective targets for performance measures and share these with the Board. I recently attended a Board meeting when the Board was discussing the data for each physician on the reappointment list in detail because they did not have targets to decide what was acceptable.

My recommendation is that every aggregate physician performance measure should have two targets, one for acceptable performance and one for excellent performance. This creates three zones that can be displayed as a scorecard with green for excellent performance, yellow for acceptable performance, and red for performance that needs follow-up. The credentials committee should provide an explanation for any reds including any improvement actions in progress. The Board could then easily scan the scorecard and explanations and be confident that physician performance was sufficiently and consistently evaluated as a basis to support the recommendations.

Sincerely,
Robert Marder, M.D.
Vice President, The Greeley Company

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