An unanticipated encounter between the Chief Medical Officer and a Physician Board Member
Recently, a chief Medical Officer (CMO) of a large hospital told me about his Board having to resolve a conflict between the hospital CEO and some of the medical staff. He related this to me because one of the physician Board members is a close personal friend of his. Their relationship has been strong and even endured occasional supervisory/ administrative conflicts inherent in their respective roles over the years. Because this present issue involved the medical staff, the CMO was also in on the decision-making process and was privy to confidential information involving the CEO. Both physicians were now concerned that their relationship could be compromised during this sensitive discussion, and both wanted to avoid potential conflicts of interests and misperceptions by the Board, the CEO and the medical staff, as this issue gets resolved.
Sounds complicated? This example demonstrates one of the more challenging interpersonal dynamics that a CMO can encounter– interacting with a physician on the medical staff who is now a member of the governing board, in effect, being the boss of someone who is now ones boss’s boss. Yes, that can be complicated.
Although most hospital trustees are community leaders in non-medical related fields, there are usually several physicians that sit on any given hospital Board. Typically, those physicians are members of the hospital medical staff and have had at least a working relationship, if not some sort of reporting relationship, or rarely even a contentious relationship, with the incumbent hospital CMO.
As the governing Board has the power to hire and fire the CEO, it is understandable for the CEO to become very protective of the Board members and should be always be aware of any relationship or potential conflict of interest between a Board member and administrative staff. I learned a long time ago in the corporate world that if you really want to get the CEO upset, just go interfere with the Board. In this example, it is doubly complicated by the fact that the issue under consideration involves the conduct of that CEO, and one of the Board members has an independent relationship with the CMO.
The CMO typically reports to the hospital CEO and has oversight over the medical staff. As part of that job, the CMO has typically overseen disciplinary actions or other issues involving individual medical staff members, and perhaps even with the physician Board member. So whether on paper or with a dotted line, the CMO is in a supervisory position with that physician Board member.
It not easy being the boss of someone who is your boss’s boss. One can easily see how numerous conflicts can occur within this interrelated circle. So, what should all three parties take into consideration if an issue such as the one above arises, as it likely will some day in your institution?
1. All parties must accept the fact that these preexisting relationships exist. Importantly, each must accept the fact that it is possible to manage the individual relationship between oneself and each individual, but it is impossible to directly influence the relationship that exists between the other two. With any three parties here will always be an independent relationship between the second and third party that the first party cannot directly influence. In human dynamics theory, this is referred to as managing the third leg of the triad. The CEO must acknowledge the interpersonal relationship of the two physicians, and that the relationship is independent of the CEO. The same applies from the perspective of the CMO or the physician Board member. Under most Board situations, this is readily manageable, but problems can arise if there are conflicts between any of the parties.
2. Either party can develop a professional conflict with the other during the course of their terms as leaders. For example, the CMO can be put in an awkward position if he/she has to do a clinical or behavioral intervention with the Board physician. The CEO would also have to be in the decision-making loop in this situation. Likewise, what about the example above where the Board has an issue with the CEO? Could the CMO be perceived as keeping something from his/her boss, when the CMO is personal friends with the CEO’s boss? Each party has to be comfortable with the limitations and confidentialities of their respective roles. Good communication is essential to minimize additional conflict and misunderstandings.
3. Physicians, practice what you preach. Physicians are used to confidential relationships. In the practice of medicine, individual patient confidentiality has to be maintained, even from family members of the patient. Even amongst physicians, except when both have a consulting relationship with the patient, they cannot talk about individual patient issues with each other except in general, non-identifying terms. The same applies here. All parties have to understand what can be communicated and what must remain confidential.
The triadic inter-dynamics between the CEO, CMO and physician Board member are really no different. The patient care model should be used as a road map. Firewalls may be needed to put in place. Certain conversations between any two of the three may now prohibited. In a more legal context, one or the other may have to recuse themselves in specific situations.
These situations, although they probably occur more often than we think, are never easy to manage. The dynamics between three crucial organizational leaders, the CMO, the CEO and physician Board members can become strained when these issues arise. Better recognition by everyone of the roles, responsibilities and functions of each party can minimize interpersonal conflicts and lead to better solutions for the entire organization.
In the case of the example CMO, all parties were able to communicate and agree upon the three principles listed above. I am happy to report that the outcome was amicably resolved for all. It could have gone down much worse!
