Five dynamic tensions in contemporary medical staffs part 3: Balancing independence and mutual accountability
Editor’s note: Mark your calendars! This series on the five dynamic tensions of the medical staff appears on the first Thursday of every month.
As we noted at the start of this series, the five dynamic tensions in contemporary medical staffs are:
- Collegiality and excellence
- Freedom and commitment
- Independence and mutual accountability
- Appreciation and continuous performance improvement
- Stability and change
“Appropriate independence” enables physicians to exercise their clinical judgment and skills in the best interests of patient care. By virtue of training, experience, board certification, and rigorous and ongoing determination of current competency, physicians exercise their privileges to ensure quality patient care. This is consistent with the physician's fiduciary responsibility to his or her patient.
However, physicians are accountable to the governing board for all of their activities within the hospital. This accountability is exercised through the democratically self-governed medical staff. By virtue of being self-governed, all members of the medical staff are mutually accountable to each other for the quality of care they provide.
The most pragmatic way to measure mutual accountability would be for members of a medical staff to imagine that they needed to bring a loved one to their hospital’s ED for an acute condition. Does it matter who is on-call that day? The on-call physician de jour is far less an issue for medical staffs high on mutual accountability.
An effective medical staff culture balances appropriate physician independence with a high level of mutual accountability. Where does your medical staff fall on this spectrum?
William K. Cors, MD, MMM, CMSL
Vice President Medical Staff Services
The Greeley Company