Medical staff effectiveness: Second in a series

Dear Medical Staff Leader,

In the April 3, 2003, issue of Medical Staff Leader Connection, I discussed the challenge of defining the function and organization of an effective medical staff. I began to explore this issue by highlighting the five major medical staff functions--quality improvement, credentialing, governance, administration, and communication. An effective medical staff should carry out these activities.

I'd like to suggest an alternative approach to defining an effective medical staff by first asking why we have an organized medical staff at all. (I will provide one answer to this question this week, and an alternative answer in the next installment of this series.) This week's answer recognizes that in today's legal and regulatory environment, the governing board is responsible for ensuring the quality of care provided throughout the organization. The board assigns primary responsibility for the quality of care on the performance of medical staff members with privileges--i.e., individual physician performance. The medical staff should also have input into quality improvement efforts for systems and processes throughout the hospital-- i.e., system performance improvement.

To borrow a concept from Stephen Covey--author, lecturer, teacher, and leadership mentor--individual physician performance can be considered the medical staff's "sphere of control." The medical staff's "sphere of influence" could be called "system performance improvement" if its definition includes staffing, capital decisions, operating room scheduling, strategic planning, and similar issues. The medical staff's "sphere of interest" is everything else related to the hospital. (It is frustrating, but it is important to note that the medical staff's sphere of interest encompasses things we care about but can't do much about.)

Working with physicians across the country has made it clear to me that medical staff members are frustrated with the waning influence of physicians, and are motivated to expand their sphere of influence. To accomplish this goal, we should consider the influence of an individual physician. Obviously, a physician who is considered a "physician's physician" has more influence than a physician with a reputation for delivering poor quality care. To expand our sphere of influence, we must perform well those tasks that fall within our sphere of control.

A truly effective medical staff is one that does what is in its sphere of control very well and successfully expands its sphere of influence. In future parts of this series, I will discuss what it takes to achieve medical staff effectiveness.

That's all for this week.

All the best,

Rick Sheff, MD