No new governance model for GPs yet – Just what the doctor ordered?

A majority of members of the Royal Australian College of General Practitioners (RACGP) voted against the proposed modernisation of their 16-year old governance structure.

As the saying goes, in the end we only regret the chances we didn’t take – I sincerely hope this will not be one of them.

At yesterday’s RACGP member meeting 45.87 percent voted for, and 54.13 percent voted against the resolution. As a result the College will continue with its 13-member representative Council model.

The modernisation proposal was the result of a member-initiated governance review process that started 3 years ago. The proposed model would have introduced skills-based board positions and a representative council that would have better reflected the membership.

The two GP-led governance structures were set up to hold each other accountable. The model was designed to create a greater diversity of voices and thinking within the College.

But it wasn’t to be. Some of the arguments against the proposal were that the board of 7 members was too small, would contain non-GPs, and that the Board-Council model was wrong.

In the end RACGP members have decided and that needs to be respected. It looks like College records have been broken with regards to voter turnout which is always a good thing – and possibly the result of the technology which allowed members to participate in the online member meeting and vote from their digital devices anywhere in Australia.

I thought it was great to see so many GPs participating in the various discussions about governance and I’d like to thank everyone for their input.

The current model has served us well. It has allowed the RACGP to grow successfully over the past years – even though it has its flaws. At some stage the College engine will need replacement, but for now we’ll continue to drive with the old one. Time for reflection.

Talking governance: Getting rid of the disconnect

As the Royal Australian College of General Practitioners (RACGP) has been growing rapidly to 34,000 members, one of the big issues the College grapples with is the perceived ‘disconnect’ between the College and its members. A new proposed governance model aims to better connect the membership with College leaders.

Every organisation needs to review itself once in a while. The RACGP last did this 16 years ago so it’s about time for an organisational update. The proposal includes a GP-led, partly skills-based Board and a larger representative Council. The two structures would be set up to hold each other accountable.

Conflicted

One of the reasons behind the proposed governance model is that the old structure is somewhat conflicted. The problem all Councillors have had up to now is that they represent a group or state within the College on the one hand, and are directors on the other.

This can lead to Councillors having to take a position such as this: “The group I am representing wants A but, putting my directors hat on, I think we should do B in the interest of the organisation” (excuse the simple example to illustrate the point).

In other words: Council, at present, may be faced with situations where it is not able to represent the membership well because directors’ duties, by law, take priority. We can’t be good directors and good representatives at the same time – but are probably managing ok overall. However, this is one of the reasons why there is a perceived structural ‘disconnect’ in the organisation.

Fresh approach

The proposed new governance model splits these two functions (representation vs directorship) between a Council and a Board which will hold each other accountable. This is an essential, but much overlooked, purpose of the new model.

It will improve the representative function of Councillors by freeing them up to work purely on behalf of our members, while Board members (directors) will mainly look after the business side of the RACGP. This model is not new and is used in other colleges and not-for-profit organisations to manage this very issue.

I believe the proposed model breathes new life into the RACGP and general practice by creating a Council that will better reflect its membership. The model creates places for New Fellows as well as Registrars and will foster new leaders with a greater diversity of voices and thinking.

Over to members now – please vote on May 30.

Disclaimer and disclosure notice. Follow me on Twitter: @EdwinKruys.

Talking Governance: Why board diversity is important for success

Should the Royal Australian College of General Practitioners (RACGP) be lead by GPs only or a more diverse mix of directors? In the lead up to the College’s general meeting on May 30 board diversity has been one of the topics of debate.

The composition of boards and councils of other Colleges has been used as an example but, more important than what has been happening so far, is where we will be in 5, 10 or 20 years time. A new Governance Model should prepare the RACGP for future challenges. This requires more than just looking at what other Colleges do today.

The Trump response

When President Donald Trump ordered a closure of the US borders to prevent Muslim refugees and visitors entering the country, the Scientific American republished How Diversity Makes Us Smarter by Katherine Phillips, Professor of Leadership and Ethics and senior vice dean at Columbia Business School.

“Simply being exposed to diversity can change the way you think”

Professor Phillips argues that diverse teams are more innovative than homogenous teams, referring to a body of research by organisational scientists, psychologists, sociologists, economists and demographers.

“Diversity enhances creativity”, she says. “It encourages the search for novel information and perspectives, leading to better decision-making and problem solving. Diversity can improve the bottom line of companies and lead to unfettered discoveries and breakthrough innovations. Even simply being exposed to diversity can change the way you think.”

Not-for-profit boards

Vernetta Walker of BoardSource, an organisation based in Washington supporting nonprofit board leadership, says that achieving diversity on a nonprofit board is a challenging but doable and essential task.

“Don’t assume everyone agrees about what diversity and inclusion mean for the board,” she says. “Before asking ‘How do we become more diverse?’ boards must ask ‘Why do we need to become diverse?’

“Boards with a good gender balance perform better”

The evidence to answer that question is coming largely from the field of gender diversity. Louise Pocock, Deputy Executive Director of the Australian Governance Leadership Centre says that several studies have shown that boards with a good gender balance perform better.

Although board diversity often refers to gender, momentum is growing that diversity is also about other aspects such as ethnic and cultural background, age, education, skills, experience and boardroom behaviours and attitudes.

“A board comprised of diverse individuals brings a variety of life experiences, capabilities and strengths to the boardroom,” she says. “There is greater diversity of thought and a broader range of insights, perspectives and views in relation to issues affecting the organisation.”

“Diversity of thought may, in turn, encourage more open-mindedness in the boardroom, help generate cognitive conflict and facilitate problem solving, and also foster greater creativity and innovation. It also reduces the risk of ‘group think’ – where board members’ efforts to achieve consensus overrides their ability to identify and realistically appraise alternative ideas or options in relation to the organisation.”

Reluctance to adapt

Sally Freeman and Peter Nash from KPMG Australia state that boards of tomorrow need to be nimble, and responsive to the rapidly changing environment.

The authors say that, in order to create board diversity it is important for boards to recognise their conscious and unconscious biases. The key to good diversity is getting the mix right to achieve a shared purpose – overcoming biases and assumptions – and then, how that mix is managed, which requires a chair who is adept at facilitating open and robust discussion. Boards don’t make a huge number of key decisions but the ones they do make need to consider the breadth of challenges and opportunities faced by the business.”

“Sometimes boards are reluctant to adapt”

“However, sometimes boards are reluctant to adapt. These are the boards that struggle to see how current social, environmental, geo-political or technological issues could impact their business – at times only recognising the consequences once it’s too late. There is further evolution required for those boards who take the view that these issues are ‘not real’ or do not impact their organisation. Diversity can assist with surviving this evolution.”

Long-term success

Suzanne Ardagh from the Australian Institute of Company Directors (AICD) says that board diversity is a component of a strong performing board and that research now shows that high performing boards are very much aware of how their board composition could contribute or detract from robust discussions, decision-making and ultimately, performance.

She says that a mindset shift is required to create more diversity on boards and that this is essential to set up an organisation for the future and for long-term success. “I would urge Chairs and Directors to make that change which society is seeking. Boards need to become more inclusive of the wide and diverse community that we are – it is an imperative that becomes more acute every day.”

“A mindset shift is required to create more diversity on boards”

Vanetta Walker advises boards to expand diversity, but limit board size. “Many organisations identify their needs for inclusiveness and diversity only to confront the biggest challenge of all: how to fill all those needs without weighing down the board with too many members. When a board is too large, some members may feel disengaged, and decision-making can become cumbersome.”

“Diversity really impacts decision-making, and good decision-making is good governance,” says CH2M Hill board member Georgia Nelson (see video). “Having diverse folks around the table really drives you to let go of conventional thinking. You get out of traditional boundaries and you begin to think about things in a different way, and by doing that innovation grows and prospers.”

Disclaimer and disclosure notice. Follow me on Twitter: @EdwinKruys.

Sources:

Critical thinking in your team

Some time ago I was at a meeting with a great team of doctors and managers. We wanted to solve a particular difficult problem. The issue was discussed at length and we decided to invest time and money to improve the situation. Months later our group’s solution turned out to be a failure. We looked at each other in disbelief and asked: Why didn’t we see this coming? Did we really make this poor decision?

There are many advantages to working in a group or team, but there are also risks. When we’re in a group we often tend to avoid conflict and follow the leading opinion. This ‘groupthink’ phenomenon has lead to many historic disasters such as  the explosion of the Space Shuttle Challenger and even the Vietnam War. Groupthink stops critical thinking and may lead to an unhealthy decision-making process. It can happen everywhere, including social networks such as Facebook and Twitter where group loyalty or group pressure may prevent airing of alternative ideas.

Last week I was watching World War Z. In this movie Brad Pitt fights the latest pandemic: a zombie apocalypse. Ten days before the pandemic is in full swing an intelligence report mentions the emergence of zombies. “Zombies? You’ve got to be kidding me,” was the response. The report was dismissed. Except… in Israel, where the intelligence service followed the ‘tenth man rule’: when nine people agree, one person – the tenth – has to prove them wrong. In the movie this person convinced the Israeli intelligence service to prepare for a zombie war – and Brad Pitt of course finds a way to save the world.

I’m not sure if the tenth man rule is real or not, but in World War Z Israel implemented this decision-making model because the Jews had been caught out too many times in history, for example during the Second World War and the Yom Kippur war. The signs on the wall were ignored by decision makers, and Israel was determined not to let this happen again. Read more in this excellent post: What World War Z Can Teach You About Critical Thinking.

There are many other ways to make better group decisions, such as looking at the risks of each decision or wearing different thinking hats. A good chair encourages critical thinking. Researchers have suggested ways to avoid groupthink. Here are 8 useful tips from psychologist Irvin Janis (borrowed from this article):

  1. Leaders should assign each member the role of ‘critical evaluator’. This allows each member to freely air objections and doubts.
  2. Leaders should not express an opinion when assigning a task to a group.
  3. Leaders should absent themselves from many of the group meetings to avoid excessively influencing the outcome.
  4. The organisation should set up several independent groups, working on the same problem.
  5. All effective alternatives should be examined.
  6. Each member should discuss the group’s ideas with trusted people outside of the group.
  7. The group should invite outside experts into meetings. Group members should be allowed to discuss with and question the outside experts.
  8. At least one group member should be assigned the role of Devil’s advocate. This should be a different person for each meeting.

How does your team encourage critical thinking?

How to save the PCEHR

The resignation of NEHTA’s top National Clinical Leads in August 2013 was the final straw for the PCEHR. I have said it before and I will say it again: if clinicians are not on board the PCEHR will fail. There are some big decisions to make by the relevant authorities if they want to save the project, and making these decisions without clinical advice is impossible.

The PCEHR Act 2012 states that the data in the PCEHR can be used for law enforcement purposes, indemnity insurance purposes for health care providers, research, public health purposes and ‘other purposes authorised by law’. This is far from reassuring. There are many grey areas and unanswered questions. There are too many agendas. The PCEHR should first be a useful clinical tool to improve patient care.

What we need is an open, well-informed discussion about the purposes of the PCEHR. What are consumers and clinicians exactly saying yes to when they sign up?

Dr Mukesh Haikerwal
Two of NEHTA’s Top National Clinical Leads: Dr Mukesh Haikerwal and Dr Nathan Pinskier in Geraldton (August 2013). Photo: Dr Ian Taylor

Consumers must know exactly what happens with their data after they have visited the doctor or the hospital. We need to agree on secondary use of the data and informed consent by clinicians and consumers is a basic requirement here. The PCEHR Act 2012 and the participation contract should both be reviewed and made 100% acceptable to consumers and clinicians.

Most of all we need genuine stakeholder engagement. This is a big challenge but certainly not impossible. Let’s hope common sense prevails.