It was an educational week at the Leadership Conference for Trustees, Physicians, Executives, & Nurse Executives at The Greenbrier in White Sulphur Springs, West Virginia. The conference, which focused on the subject of governance, was organized by The Governance Institute. Although not a new term, governance has taken a much higher profile in both for profit and not for profit organizations. At a very high level governance aims to assure that an organization produces a pattern of good results while avoiding an undesirable pattern of bad circumstances. The Governance Institute focuses on helping hospitals achieve best practices among the leading healthcare boards across the country.
The conference included three days of speeches, Q&A, and breakout sessions that covered many topics including clarification of a hospital board’s basic fiduciary duties and core responsibilities, exploration of "best practices" of high-performing boards, understanding of various hospital-physican relationships and complexities of physician credentialing and privileging, approaches to hospital financial planning and capital allocation, and an analysis of the healthcare reform (and cost) being advocated by the various political candidates.
Governance can be a complex topic but at a high level it is mostly common sense. The way I think about it, good governance means being financially efficient but not pushing so hard on the numbers as to cause people to do unnatural things in order to "make" the numbers, focusing on how the leadership of the organization is selected and how they are paid, being transparent with the various stakeholders so they understand the decisions that are made and the rationale behind them, and insuring personal accountability is in place at all levels.
Although governance was the main focus of the conference, all of the speakers had some predictions about where things are headed with American healthcare. It was not a pretty picture. Costs are going to cointinue to escalate to the point where they are a huge part of the economy and exceed the cost of primary and secondary education at the state level. As costs rise they will be pushed toward hospitals and pressures will continue between payers (insurers) and providers. Primary care physicians, already in short supply in many areas, will be in even shorter supply as new graduates seek out speciality areas with more economic potential. As the cost of running a medical practice continues to increase many doctors will choose to become employees of hospitals. Hospitals will consolidate and as they gain economy of scale they will implement electronic medical records and become highly efficient providers of high quality care. Although America does not today offer the highest quality health care in the world, there is significant progress being made toward curing cancer and heart disease. The glass is half full, not half empty.
There was not a lot of spare time but enough to get in a look around the Greenbrier’s spectacular 3,500+ acres, have a good hike up Kates Mountain Road, and also locate a benchmark near the old White Sulphur Springs train station (a few pictures in the photo gallery). That brings cumulative benchmarks found to eighty-eight. Some of my colleagues took a tour of the Bunker but we had been there before.

• Other patrickWeb stories about healthcare
• Pictures from 2002 trip to the Bunker