There’s an important reason why physician groups must do away with overly democratic or consensus style systems of governance: Those approaches make it impossible for the group to adopt a strategic, as opposed to a tactical, outlook.
Take a consensus style group that is unable to come to terms in respect of the expanded office hours demanded by a large number of referring physicians in the community. From a purely tactical standpoint, the group ventures into the question of the cost of the extra hours of operation and, although unspoken, of the convenience factor as run through each doctor’s personal filter.
But the strategic analysis is very different: If we value their referrals, how do continue to obtain the ongoing business of the physicians in our community who are already referring to us? This, of course, requires an understanding of the concept of lifetime value.
As to the question of who should be making that decision, true democracy doesn’t work in business any more than it works in running a city, state or nation. As I advise clients, I’m a strong proponent of the “strong leader” form of governance. Whether that leader is grandfathered in or elected every year or two is an issue that turns on the culture of the specific group. If elections are the culture, that’s where democracy comes into play: representative democracy.
Leaders must be empowered to lead. Not all of their decisions will be good ones, so they must be free to fail as well as to succeed. Requiring a group vote or establishing a board consisting of all of the shareholders guts leadership and replaces it with its poor relation, consensus, which by nature suffers from the defects of peer pressure and compromise.
Lead, follow or get out of the way. Or, as the English author G.K. Chesterton poetically put it, “I’ve searched all the parks in all the cities and found no statues of committees.”