Medical Staff Culture- Part 3

Dear medical staff leader:

The primary function of a medical staff leader is to help other fellow physicians be the best physicians they can be. However, to achieve this goal, a strong medical staff culture needs to be collegial, respectful, and professional.

In this culture, physicians must also hold other fellow physicians accountable for their behavior and the quality of care they provide.
As peers, physicians often have a difficult time holding each other accountable.

Reasons for this include referral relationships, friendships, the simple nature of being peers, and the recognition of "there but for the grace of God go I."

All medical staffs face the challenge of holding their peers accountable for excellence while at the same time preserving collegiality and appropriate physician independence.

Doing so through a democratically self-governed medical staff, with frequent changes in leadership, is even more challenging.

Ineffective handling of this challenge can lead to medical staff disharmony at a minimum, distrust and conflict in many instances, and open warfare in the worst cases.

The following are some practical tips you can follow to help your medical staff balance these challenges more effectively:

Get colleagues together to talk about clinical medicine
Medical staff leaders should actively create opportunities for physicians to meet for reasons other than to conduct organized medical staff work. Methods here include journal clubs, forums to discuss interesting cases without "scoring" them, and interdisciplinary case conferences such as endovascular, cardiac, or oncology.

Invest in social capital
Great collegiality does not occur by accident. It requires making deposits in an "emotional bank account" with peers. This simple premise, under this social capital principle, is that people who play together have a harder time fighting with each other. A medical staff social committee can be useful in planning social events for meeting this challenge.

Develop physician-designed expectations of performance
All too often, physicians believe that others tell them how to practice medicine. But, actually, it's time for physicians to decide what good quality medical care should be. Physician leaders should engage their entire staff in a serious discussion of what constitutes good medical practice. The Power of the Pyramid, as taught by The Greeley Company, is a useful tool for medical staff leaders to achieve this.

Redesign peer review
The inherently subjective nature of peer review, as most medical staffs carry it out today, is the root cause of friction in medical staffs.
Remember, physicians love to discuss cases but hate to "score" them. If you still conduct most of your peer review by examining individual charts, take this opportunity to redesign peer review.
When medical staffs shift from reviewing a lot of charts, usually without producing much improvement in patient care, to using rule and rate indicators, they allow physicians to establish targets of what constitutes good medical care and how it should be measured. As a result, collegiality improves, as does the quality of medical care.

Managing conflicts
Building trust and mutual respect in an organization can reduce conflicts but cannot eliminate them. It is inevitable that conflicts will arise, and when they do it is essential for leaders to have a system in place to manage them appropriately. Formal training in principled negotiation, polarity management, and conflict resolution are important elements of a medical staff leader development and training program. 

Next month, in Part 4, I'll address the challenges of cultural diversity. Until then, stay well and be the best you can be.

William K. Cors, MD, MMM, FACPE
The Greeley Company