Collect quality reports from contracted groups

Dear Medical Staff Leader,

When was the last time your medical executive committee (MEC) got a comprehensive report from groups with whom your hospital has an exclusive or nonexclusive contract on the quality of care and service they provide? You should expect these outside contractors--which provide services that include radiology, pathology, emergency medicine, and anesthesia--to monitor and improve the quality of their services routinely, just as departments of the medical staff do.

But too often, the MEC receives only sketchy reports from the directors of these contractors, saying there are "no problems" or that studies are "in progress."

The MEC can take a far more enlightened approach to this problem by recognizing the enormous power of inserting pre-existing performance standards into the contract between an institution and its contract groups.

Although many contracts between hospitals and outside professional groups contain vague references to expected performance, these references often lack objectivity. For example: "The contractee agrees to provide professional services at the generally recognized standard, and agrees to provide staffing sufficient to meet demand, and agrees to operate the department in compliance with all relevant laws and JCAHO standards." These contractual expectations may seem reasonable, but they lack sufficient detail to provide the basis for a sound routine report to either the hospital's management or the MEC.

Far more precise standards are now required. Members of the MEC should help hospital management develop precise performance standards addressing management, service quality, professional quality, resource utilization, and staffing. Such standards, if used properly, can give all parties (the contract group, management, and the MEC) great comfort.

The contract group will be comfortable knowing exactly what the hospital expects of it. Management will be comfortable knowing that the group is committed to the expectations laid down in the contract and that the hospital has a reliable way through which to routinely evaluate the group's performance under the contract, and for contract renewals. The MEC will be comfortable with the fact that it will be getting routine reports reflecting the groups' performance.

All in all, sound performance standards help solidify a great relationship and extend it long into the future.

That's all for this week.

All the best,

Hugh Greeley