Bylaws: Table of contents

In the traditional approach to medical staff bylaws construction, the table of contents is placed at the beginning of the document and enables all parties to quickly locate the pages on which to find relevant articles, sections, and provisions. Some medical staff bylaws include a table of contents that lists headings corresponding to each and every major and minor subheading within the document. The result is a table of contents as long as 12 pages.

Although such a detailed table of contents allows for the identification of all sections of the bylaws and their page numbers, it also creates the impression that the bylaws are a dense and bureaucratic document. Further, the clerical task of updating the table of contents can be significant when revisions and amendments change the page numbering of every section.

If you choose to follow traditional methods of constructing the table of contents, place it at the beginning of the document and consider referencing only the major chapters within the bylaws, such as

• purpose
• organization name
• appointment to the medical staff
• medical staff categories
• medical staff officers
• organizational structure
• investigations and corrective action
• fair hearing
• meetings, quorum, and attendance
• method of bylaws' adoption

A medical staff that seeks to create more user-friendly bylaws might begin the document with only a short reference to the material it contains. Instead of placing the complete table of contents in the beginning of the document, consider moving it to the last few pages. This change will help ensure that physicians who have an interest in reading the bylaws are not put off by first having to wade through a lengthy contents section. Alternatively, give new applicants and other physicians a set of bylaws that contains only an abbreviated table of contents, and maintain a separate, more detailed index within the medical staff office. The more extensively indexed set of bylaws could be provided to the medical staff officers and to any other staff physicians on request.

The medical staff bylaws might also be summarized in a brief narrative description of each chapter's contents. The chief of staff should write this narrative in a style and tone that increase the likelihood that physicians will read it, and it should serve as the physicians' introduction to the medical staff structure and processes. All new medical staff members should receive this material. These physicians should also be directed to a complete set of medical staff bylaws available on the hospital's Web site and through the medical staff office. Additional copies of current medical staff bylaws could be maintained, in a bound format, in the medical staff lounge and medical staff library.

That's all for this week!

All the best,

Todd Sagin, MD, JD
National Medical Director
The Greeley Company