With the looming changes in healthcare, it is more important than ever that the three-legged stool of hospital operations--board of trustees, medical staff and executive management--works seamlessly together for the good of the hospital organization and the community as a whole. 
Many hospitals and health systems now believe the key to future success will be our ability to develop integrated delivery systems. At the core of such systems is the ability to achieve hospital and physician alignment.
Recently I began working with a hospital that was struggling to find common ground among the board, medical staff and administration. The publicly owned hospital had experienced very high CEO turnover over the years, as well as had 100 percent turnover in the board of directors within the past two years.
Although the hospital was blessed with a highly qualified and energetic board of directors, excellent doctors and a good strategic plan, it had been struggling. Due largely to high leadership turnover, there were tentative relationships between the key members of the organization that resulted in financial challenges for the hospital.
When speaking to the individual board members and medical staff, I found there was more common ground between the members of each group than any of us realized. Both sides identified the importance of building a strong foundation of well-trained physicians that were loyal to the hospital, a high-quality hospital, mutual trust and respect, and open and honest communication between the board and medical staff as priorities.
I truly believed the board, medical staff and hospital leadership realized that if they did not begin to work together effectively, the organization would continue to decline.
The truth of the matter was the board and medical staff did not know each other very well. So we identified an opportunity to go back to basics and start with some fundamental team building.
With the help of a qualified facilitator, we created a safe environment where the board of directors, organized medical staff and executive management team could all meet together and talk about what had--and had not--worked in the past, as well as the needs for better communication and coordination in the future.
In some cases, members of the board and the medical staff were meeting each other for the first time. I became amazed to learn that such a meeting had not taken place before. Through this first step of communication and getting to know each other, we have committed to an action plan for developing this important relationship.
A joint conference committee with two members of the board, two members of the medical staff and the hospital CEO now exists and will begin meeting regularly.
Additionally, the hospital created a newly expanded role for the chief of the medical staff within the board structure. The hospital also committed to providing more support for the medical staff function.
For the first time in a while, we are seeing trust being rebuilt and the entire leadership of our hospital working together.
If you haven't worked on building the team of your three-legged stool at your hospital recently, and if you are finding the board and medical staff are not working effectively together, then perhaps it's time for team building at your hospital too.
Raymond Hino, MPA, FACHE is vice president of Healthcare Advisory Services, Inc and a board member of the Health Research & Education Trust. Previously, he served as Chief Executive Officer of Mendocino Coast District Hospital in Fort Bragg, California.