Manage departmental territorialism

A challenge that occurs for some medical staffs relates less to the granting of privileges than to the exercise of privileges. Departmental territorialism can occur within organizations and lead to many issues. For example, consider the following scenario. A vascular surgeon is granted privileges to perform peripheral embolectomy. However, according to hospital policy, this procedure must be performed in the interventional radiology suite. Scheduling for the interventional radiology suite is the responsibility of the department of radiology, which is heavily influenced by the radiologists. The vascular surgeon has an urgent case but cannot book it because there is no time available in the interventional radiology suite. However, the radiology department states that if a radiologist performs the procedure, it may be possible to “squeeze the patient into the schedule.” Such an accommodation was not available to the surgeon.

Credentialing decisions should always be based on the interests of patients, yet such disputes are based on money and control rather than on the best interests of patients. Hospital management must be aware that control over the sites where privileges are exercised should not “belong” to any particular group of physicians. Instead, hospital resources, such as the interventional radiology suite, should be used in a manner that maximizes clinical outcomes, cost-effectiveness, and patient satisfaction, not in a manner that protects the domain of any particular physician or group of physicians.

In other words, where a particular privilege is exercised and how it is scheduled is not a medical staff issue. It is a hospital management responsibility that must be exercised in the best interests of patient care.