Bylaws and governance monthly: Do you have problems getting a quorum at meetings?

Many medical staffs have difficulty getting their work done, often because they do not have a quorum at meetings and therefore cannot vote on important issues. If physicians feel that meetings are a waste of their valuable time, they cast their votes by not showing up at meetings at all. So how do we get the work done? Below are some suggestions to help you get on the right track.

1. Consider whether the meeting is truly a medical staff meeting or could be better served as a hospital meeting with medical staff participation. For example, some meetings, such as infection control and blood utilization, may more appropriately be run as hospital committees rather than medical staff committees. In many cases, these committees are able to accomplish work regardless of whether a medical staff member quorum is met. Some hospitals limit standing medical staff committees to three: medical executive committee (MEC), credentials committee, and a medical staff quality committee. They send representatives or liaisons to the hospital meetings, but at these meetings, the medical staff are not the only people considered in quorum requirements.
2. If the medical staff cannot let go of certain committees, consider which committees need the input of a large number of physicians to make decisions that are accepted by the majority of the medical staff. Then consider the committees that do not require such a high level of physician participation. Many medical staffs have a significant quorum (50%) for the three big committee meetings (MEC, credentials, and quality). For all other meetings (infection control, medical records, etc.), they define quorum as those voting members present. So if some committees remain medical staff committees, they could get legitimate work done with the presence of one voting medical staff member.
3. Consider other methods of voting. For some big ticket issues, such as bylaws amendments, we have seen some medical staffs struggle because they are unable to get a quorum to vote, yet they want people to weigh in on these important decisions. Many have switched from voting in person to voting by ballot. But there are some medical staffs that still cannot reach a quorum by using ballots. At that point, it is time to consider some creative alternatives, such as adopting voting rules that are not waylaid by physician apathy. For example, when you have a good meal at a restaurant, do you fill out the comment card? I bet the answer is usually no. Yet, when you dine in a restaurant and the meal is terrible, I bet there is a much greater chance that you fill out the comment card. You can use this same rationale when considering voting methods for the medical staff. Disgruntled people are more often likely to vote than those who are happy or could live with either a “yes” or a “no.”

Many medical staffs are now adopting voting rules that allow a motion to pass unless a certain percentage of the ballots are returned with a negative vote. If you want 2/3 of voters to approve the motion, then the motion is defeated by a return of 1/3 of the ballots as “no.” To make this method work, you have to ensure clear communication of the issues to everyone on the medical staff and have a good balloting method. Many medical staffs are finding this a time-efficient method of voting while still respecting members’ right to vote.

So when you are hamstrung by an inability to get a legitimate vote, consider the big three questions:

1. Is this meeting/committee one in which only medical staff members can vote?
2. What is the appropriate quorum requirement for a legitimate vote?
3. Can we consider alternative methods of voting if we are having difficulty getting a quorum in person?

Mary Hoppa, MD, MBA, CMSL is a senior consultant with The Greeley Company, a division of HCPro, Inc., in Marblehead, MA.