Overly democratic or consensus style systems of medical group governance make it impossible for the group to adopt a strategic, as opposed to a tactical, outlook.
For example, consider a consensus style forty-three physician orthopedic group that’s unable to come to agreement on how to respond to an important referral source’s request that they expand their office hours on Fridays. From a purely tactical standpoint, the group considers 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 them?
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 — it’s slow and inefficient.
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. And, I’m not saying that boards of directors, or their equivalent, aren’t important; I’m simply saying that day to day business decisions, as opposed to policy decisions, belong at the operational level.
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.”
