We have reached an important milestone: SHM is 10 years old. As with all such anniversaries, it’s a good a time to reflect upon what we’ve achieved and decide our future objectives.
But to assess SHM’s progress, we must first know more about its past. The society was formed with the following objectives, found in our mission statement and declaration of goals:
SHM is dedicated to promoting the highest quality care for all hospitalized patients. The society is committed to promoting excellence in the practice of hospital medicine through education, advocacy, and research.
- Promote high-quality care for all hospitalized patients;
- Promote education and research in hospital medicine;
- Promote teamwork to achieve the best possible care for hospitalized patients;
- Advocate a career path that will attract and retain the highest quality hospitalists;
- Define the competencies, activities, and needs of the hospitalist community; and
- Propose, support, and promote changes to the healthcare system that lead to higher quality, more efficient care for all hospitalized patients.
These are commendable goals, indeed. Achieving them is the responsibility of our Board of Directors, which is tasked with providing governance and guiding the society and its members in accordance with these objectives.
How does the SHM and our board make these real-world choices? Let’s take a closer look at the board and its thinking.
SHM’s bottom line is the care of our patients. It is the fundamental goal that sets us apart from for-profit companies where success is measured purely by financial returns. SHM and other medical societies also differ from for-profits in other fundamental ways. Our boards are composed of unpaid volunteers, and our power structures are diffuse rather than concentrated in a single, powerful CEO.
In addition, our board, like the boards of other medical societies, hires the CEO, provides for the election of board officers, and approves and manages the budget. It also supplies the leadership to guide our programs and evaluate our progress toward the goals it has set. Along with our executive staff, the board also oversees all strategic planning, relationships with other organizations, allocation of resources, membership growth, advocacy, and fundraising.
These functions and responsibilities are all attributes of good social-sector organizations. But our board strives for more than that. We want greatness, as defined by business researcher and author Jim Collins, in his monograph Good to Great and the Social Sectors. Assessing greatness, he says, comes down to one critical question: “How effectively do we deliver on our mission and make a distinctive impact, relative to our resources?”
There are seven key criteria derived from Collins’ research on greatness that you can use to assess the effectiveness of the SHM board.
- Were the activities we engaged in consistent with the mission?
- How much impact did we make, relative to our resources?
- What qualitative and quantitative achievements did the organization reach over the past year?
- Do the board’s actions and decisions endure, even when board members and officers change?
- Is the organization growing in terms of resources (revenues, membership, contributors)?
- Does the board build on its successes?
- Is the board clear about tough choices regarding what it can and cannot do?
It is in SHM’s single-minded allegiance to our mission where our choices have stood out from those of other medical societies. Some other societies spend [time and money] on protecting turf, defending professional fees, or advocating for higher reimbursement. Our prime focus—straight from our mission statement—has always been upon our patients. Our priorities revolve around patients and the hospital care setting. They revolve around how we can improve patient care, preserve resources, advance the education of our members, advance hospital medicine research, and partner with other healthcare professionals.
These are laudatory aims, but we have to remember that we work in an environment of limited—and competing—organizational resources. The board must make hard and sometimes unpopular choices regarding which projects, positions, or initiatives we undertake, and which we must say no to. This is the reality we live with. This is the discipline the board must exercise. We simply cannot do it all. And that means we cannot please everyone all the time.
The board hears its members when they ask, “Why aren’t you doing this?”—“this” being a variety of valuable projects competing for more valuable time and resources.
One of the board’s thornier issues has been deciding whether or not to accept money from Big Pharma, as some other medical organizations do. Other contentious issues include whether to weigh in on appropriate workloads for individual physicians or lobby for more reimbursement, especially from Medicare. Reasonable people can and do have differing opinions on these and other difficult issues. But the board must weigh each issue against our mission and goals and make a final judgment.
The board is responsible not only for what we do but how we do it. We must be thorough in our decision-making to avoid—or at least mitigate—unintended consequences. We must endeavor to always remain ethical in all our positions and dealings. As we focus on these important and difficult issues, the board will hold to one overriding principle: Make SHM a great organization that believes in its core values while constantly adapting to a changing environment.
Collins summed it up this way: “Greatness is not a function of circumstance. Greatness, it turns out, is a matter of conscious choice and discipline.” TH
Dr. Holman is the president of SHM.