The Power of Clinical Advisors, Part I: Navigating A Unique Governance Model

Concluding a grant-funded HIT initiative at the Fort Drum Regional Health Planning Organization (FDRHPO) has led me to reflect on one of the project’s best assets: its clinical advisory committee. The first segment of this two-part series will examine the opportunities and challenges that come with having a unique governance model.

The FDRHPO created the Provider Executive Committee (PEC) as part of its Health Efficiency and Affordability Law for New Yorkers (HEAL-NY) Phase 10 project in 2010, and looking back, I think we struck gold with the PEC. Guidance from the now 24-member committee — which includes 22 of the region’s leading physicians — has profoundly shaped the way the FDRHPO has pursued HIT initiatives.

A Unique Governing Structure

With the institution of the PEC, the FDRHPO developed a unique governing structure to best serve the health needs of community. The FDRHPO is a not-for-profit 501(c) collaborative of seven hospitals and 48 practice locations that applies for and manages grant-funded initiatives on behalf of our member network. The primary mission of the FDRHPO is to strengthen the regional healthcare system for soldiers, their families, and the surrounding civilian community.

The FDRHPO governance structure is unique in that it is community-based and stakeholder-driven; the people who are most affected by the changes we enact are the ones with the most powerful voices in determining what changes to make. Our board of directors consists of executives from our member hospitals, as well as leaders from county public health departments, emergency medical services organizations, and behavioral health. In addition to the board of directors, there is the PEC, which is part of the North Country Health Information Partnership (N-CHIP) formed by our HEAL-NY 10 capital project.

Beneath the PEC are various workgroups, subcommittees, and steering committees that are created and dissolved as necessary to align with current projects and initiatives. For instance, we have a Patient Centered Medical Home (PCMH) subcommittee focused on standardizing the process of achieving PCMH recognition, and an HIE Clinical Subcommittee.

The PEC meets quarterly to put forward ideas and discuss how different initiatives will impact specific individuals as well as the community as a whole. Ideas are then staffed to the FDRHPO or N-CHIP, which then draft proposals to be presented back to the PEC. Upon approval by the PEC, the proposal reaches the FDRHPO Board of Directors for review.

Compare this to the typical health system’s governance structure. Hospitals, for instance, are usually presided over by a board of trustees containing community leaders. Below the board of trustees is a direct chain of command from management down.

The hierarchical governance approach is more likely than the community-based partnership model to allow HIT initiatives to be imposed on the system rather than shaped by it. Implementing new technology without the input of the clinicians and staff members who utilize the technology on a daily basis can cause health system leadership to put the cart before the horse — to implement a solution first and later shape the problem to match, rather than the other way around.

[The second part of this blog will focus on how the FDRHPO leverages PEC’s clinical leadership to prioritize IT needs, and how the organization manages challenges that arise from having a non-traditional governance structure.]