Medical staff effectiveness: Fourth in a series

Dear Medical Staff Leader,

In this series on medical staff effectiveness, I have

• identified the five functions of the medical staff (quality, credentialing, governance, administration, and communication)
• defined an effective medical staff as one that does well with what falls within its sphere of control while simultaneously expanding its sphere of influence
• recognized that while carrying out the medical staff's primary responsibility for quality, physician leaders must also balance the dual challenges of advocating for the interests of physicians and creating a powerful sphere of influence by collaborating with management to achieve organizational success

To fill the tall order these challenges present, medical staffs require structure and processes that are efficient and effective, a strong medical staff culture, a clear strategy for win-win collaboration with the hospital, and great physician leaders. Let's briefly consider each of these elements.

The medical staff must first self-organize to carry out its activities, which requires physicians to develop efficient and effective structures and processes. The medical staff structure, which includes how it governs and organizes itself, is defined by the bylaws and associated documents. The bylaws often define how medical staffs carry out processes such as privileging and peer review. However, many medical staffs have pulled the descriptions of these activities out of their bylaws and put them in policies or manuals that may be changed by a medical executive committee vote rather than through the cumbersome and time-consuming bylaws amendment process. This tool allows medical staffs to constantly make improvements for greater efficiency and effectiveness. Unfortunately, the structure and processes for most medical staffs are anything but efficient and effective, and opportunities for improvement abound.

A strong medical staff culture--collegial, respectful, and professional--is another required element of an effective medical staff. Keep in mind that this culture also must be one in which physicians hold their fellow physicians mutually accountable for their behavior and the quality of the care they provide. Does your medical staff have a culture of mutual accountability? If yes, congratulate yourselves. If not, this is another opportunity for improvement.

To optimize influence, the medical staff must develop win-win strategies for collaborating with the hospital. A medical staff that does not advocate for the interests of its physicians will not have the support of those physicians, but a medical staff that does not support the success of the hospital will have little influence with the hospital board and senior management. Therefore a strategy that aligns the medical staff's and the hospital's activities is required.

Finally, none of these elements is possible without strong medical staff leadership. This requires a well-planned and well-executed program for medical staff leadership development and succession.

All four of these elements (structure and processes, culture, strategy, and leadership) are essential for achieving a truly effective medical staff.

That's all for this week.

All the best,

Rick Sheff, MD