Episode Four: Restructuring Intermountain Medical Group’s Board to Encourage Greater Clinician Engagement

Mark Briesacher, MD: Hi. I'm Mark Briesacher. I'm the president of the Intermountain Medical Group. I'm here with Doctor Karyn Springer. Hi Karyn.

Karyn Springer, MD: Hi Mark. Thanks so much for having me here.

Mark Briesacher, MD: Karyn is a family medicine physician for us at our north Orem clinic. She's most importantly the chairperson of the Intermountain Medical Group board. I was thinking about when was the first time we met, and it was ... I couldn't remember if it was something related to the residency program that you're a faculty member of down in Utah valley, or a medical group meeting, but I'm pretty sure when you joined the board eight years ago, was when we really started to see each other on a regular basis.

Karyn Springer, MD: Yeah. That's what I was thinking too. I don't know if there was one specific time that we met, but probably a few times we met, until we finally got to know each other.

Mark Briesacher, MD: Yeah. We since then have had a lot of laughs...We got to talk about some hard things and some fun things.

Karyn Springer, MD: Nothing's changed.

Mark Briesacher, MD: Right. We still talk about all those things. You know, I wanted to talk to you today about the governance model that the medical group board is working on. We started back in February with this idea of, wow, after some 15 plus years, it's probably time to take a look at our governance model and think about how it fits in to becoming the best medical group going forward. It's been very remarkable, the work that has transpired over the past three months. I thought it was really important that both the physicians and APC's in our medical group, as well as even other medical groups. You know, they hear about what we're working on. My question to start off is, why, from your perspective, why is this the right time to do this work, to look at our model of governance?

Karyn Springer, MD: Yeah. Absolutely. You know, Mark, the healthcare environment is very different from where we were when we first started as a medical group back in 1994. Obviously, when I think about some of the things I was just starting medical school. I don't know firsthand of all the different experiences, but I think one of the big things is, you know, we had paper charts. We had private practice. We didn't have our medical record systems. Certainly didn't have what I lovingly call our alphabet soup of medicine today, right? ACO, MIPS, MACRA, all those things, right? Completely different. As we looked at how can the medical group be successful, in this new environment, we recognized, hey, we were very progressive back in 1994, in terms of establishing bi-laws, establishing a medical group as part of a system. We need to be progressive again, and really strengthen our governance model, in order to be having the leadership structure that we needed to be successful.

Mark Briesacher, MD: You know, I was so impressed with our board members, who were listening really hard to what our front line physicians and APC's were saying. They wanted greater voice in strategy. They want a greater involvement in overseeing how the medical group is run. This is a real opportunity to, you know, we've listened really closely and being very intentional about responding to what they have asked of us.

Karyn Springer, MD: Yeah. Absolutely. The number one thing that I think I hear from our front line physicians and APC's is, we want to be more involved, right?

Mark Briesacher, MD: Agree.

Karyn Springer, MD: We want to have say. We have good idea. We're frontline. We want to be engaged and I think the opportunity that we started back in the beginning of this year to, really look at our leadership structure, will provide that framework, that they need in order to be more engaged, and for us actually as leaders to hear their voice more, right? And so, absolutely, I think the number one reason why this change is so important, beyond just you know, what we need to be successful is because this is what our physicians and APC's have wanted. Right?

Mark Briesacher, MD: That's right. I want to hit the big change head on here. The strength of the board in the past has been its diversity.

Karyn Springer, MD: Yes.

Mark Briesacher, MD: Right? Representation from all of our communities in which medical group physicians and APC's work in and where do they care for people. The diversity of specialties. The board has approved a change from regional representation to now, a nomination and appointment process that a nominating and governance committee is responsible for. As you have worked with the nominating governance committee, which is led by Doctor Mark Milligan, one of our family physicians in Layton. How are they going to assure our frontline teams that same amount of diversity is going to be there?

Karyn Springer, MD: Yeah. That's absolutely a huge change, right, from this elected model of regional representation to more of a nominating model. I think the thing that's going to make the biggest difference is something that we actually discussed with our board was, what competencies and diversity should our board have, and it's members. By doing that, we really will pull together the people who really understand what it means to represent Intermountain. It's interesting because the diversity is a key role, right? We're a diverse medical group. But yet, we also can't have one of everything...

Mark Briesacher, MD: Right.

Karyn Springer, MD: on our board. I think it speaks to, going back to those competencies of people who can understand. We do have people who have the diversity in where they practice, or what they practice, gender, like you said, and race, other things. There's also very much a leadership quality of being able to understand diversity, right? That's really, I think the role of the nominating governance committee. I mean, that's a huge role for them to take a look at the many different people who have been nominated, or who have that leadership potential, or experience throughout our group, and say, "Okay. What makes sense of who we need at the board level, to guide the medical group?" Giving them the competency structure to look at that, I think will help them be successful and creating that board, that needs and understands that diversity.

Mark Briesacher, MD: Another change is the actual size of our board. We're going from a board that is 25, 26 down to 13. I wonder if you could share with the group and others, how the committee structure is actually going to open up a lot of opportunity for rising leaders and physicians in advance practice clinicians, who have great potential from a leadership and governance perspective to step into a new role and have an opportunity to grow and develop.

Karyn Springer, MD: This is probably the most exciting thing for me in terms of this structure change, is the strengthening of our committees. Like you said, the board itself will be smaller. When we looked at, just best practices of other large corporations, healthcare, not healthcare, their boards were quite a bit smaller as you remember.

Mark Briesacher, MD: Right.

Karyn Springer, MD: Some only three or five people for a large corporation. That made us really think, okay, how can we get the same physician and APC involvement, but have a smaller board? The committee structure that we are creating is very strong and much more strongly linked with the medical group board than in the past. Right?

Each of these will be aligned with one of our fundamentals, and will allow for additional physician, APC's, even potentially nurse leaders and other medical group leaders, who have that experience in say, patient safety and experience, or in fundamental of access, or one of those things. That allows a large group of physicians and clinicians to participate in understanding the strategic direction of the medical group, and giving input. That's really where most of the work happens, right?

Mark Briesacher, MD: That's right.

Karyn Springer, MD: It gets presented back to the board, just to make sure we're still aligned with our strategic direction. The committee structure is an awesome place where new leaders can be developed, and maybe people who have had some experience, but maybe not system experience. We, by doing that are not only allowing more people to be engaged, but we are actually helping train for the future, right?

Mark Briesacher, MD: That's right, which is so important.

Karyn Springer, MD: Which is so important to have that planning to, "Okay. Who are we going to bring up?" I fully expect that future board members will come a lot from the current committee membership.

Mark Briesacher, MD: That's right.

Karyn Springer, MD: Yeah.

Mark Briesacher, MD: Yeah. You mentioned our fundamentals of extraordinary care, which are safety, quality, patient experience, access, and stewardship. All of that great care happening within a context of engaged caregivers. It really ties back to our mission, which is helping people live the healthiest lives possible. What's remarkable about these changes, that our board is undertaking, is that it really does, it starts with how can we be organized in such a way to care for people, to care for patients and families, and the communities where we all live and where we serve others.

I think the opportunity to bring together committed physicians and advanced practice clinicians around these fundamentals ... Let's find the people who are really interested and committed to advancing the experience of care, and really understanding that, and would be able to guide our management and operations leaders in strategies to be better and better in that area. The same is true with safety, quality, and the other fundamentals as well. This is just a tremendous opportunity for us.

Karyn Springer, MD: Yeah. The whole one Intermountain concept that we've been talking about.

Mark Briesacher, MD: Yes.

Karyn Springer, MD: These changes with our medical group board aligns completely, right, with that direction. Your absolutely right where, if we find those champions of who our front line providers ... There are a lot of smart, smart people...

Mark Briesacher, MD: Right.

Karyn Springer, MD: in the medical group. We need to find how to really tap into their excitement, their experience. I really feel that a lot of the solutions are going to come if we look at the workflow, and seeing patients, what's best for patients, and who better than our front line leaders, who can give us those suggestions to kind of help us align. Let's figure out, you know, okay, yes from there. Then, let's give it over to people who can figure out how to operationalize it. Right? Yeah. That's a very exciting part of that, where we can really engage a lot of physicians and APC's in the work that they do every day, and how to make sure that we take care of our patients throughout our group.

Mark Briesacher, MD: Well, I can't thank you enough for leading this effort. I think one of the key factors for success for any group that's thinking about doing this, is that you need a strong leader of your board, who will take the helm and work with other's to push this forward to define and continuously link it to mission and common purpose, who is a tireless advocate for front line caregivers in our group, and an amazing leader of the medical group board. I feel pretty lucky to have you as a boss, my boss, right? I know we laugh about this.

Karyn Springer, MD: Yes. We laugh at that. The one percent me, your boss and the 99% you. You're my boss.

Mark Briesacher, MD: It's great having a boss like you, a leader like you to help with medical group strategy and oversight of execution. I'm really mostly thankful for your tireless advocacy for front line physicians and advance practice clinicians. Thank you so much.

Karyn Springer, MD: Yeah. Thank you Mark.