Medical staff governance: Select capable leaders
Dear Medical Staff Leader,
Democracy can be a messy form of governance, but it's arguably better than all other forms. For decades, hospital medical staffs have organized themselves according to democratic principles. Early in their evolution, the medical staff met to make collective decisions--much like the town meetings in the country's first settled communities. As the medical staff grew too large to meet and make collective decisions, medical executive committees (MEC) were formed to act in the best interest of the medical staff. MEC members were democratically elected to their position. As the medical staff continued to evolve, medical staff officers were selected by majority vote and nearly every physician had his or her turn (too often considered a "sentence" by those selected to serve).
The MEC was not required to confront difficult issues until the emergence of DRGs, outpatient migration, managed care, and a plethora of federal, state, and private requirements. The complexities of today's health care environment challenge our medical staffs to maintain collegial democracy while attempting to resolve contentious situations.
Despite the need for effective leadership in these difficult times, examples of bad leadership abound. A hospital recently contacted me to discuss its medical staff's decision to elect one of its most disruptive physicians to the MEC. At another facility, an elected officer is in the midst of complex and divisive litigation with the hospital and the past MEC. In yet another hospital, the staff has elected a physician who delights in writing letters to the press castigating the hospital and medical staff members. And in too many hospitals, the medical staff continues to select its president based on a "schedule" or because the physician was out of town during the election.
It's important to end such practices. Medical staffs must be cautious when electing physicians to become part of the management structure, hold a seat on the board, participate in planning, and be accountable to the board for the quality of services provided. When democracies elect individuals who cannot or will not lead, anarchy takes root and dictators emerge. Years of progress are jeopardized and the board is forced to take action to dramatically change the status quo.
That's all for this week.
All the best,