The physician leader's role in fair hearings

Understanding your role and responsibilities during corrective actions and fair hearings can be the first step in relieving stress due to uncertainty. And according to Jack L. Cox, MD, MMM, senior vice president and chief quality officer for Hoag, a regional healthcare delivery network in Orange County, California, this starts with medical staff leaders developing an ironclad policy and procedures—before it is time to take corrective action.

"There are two scenarios you do not want to get caught in. The first is not having a solid policy that has been vetted. The second is getting caught having to do this at the last minute when an emergency arises," says Cox. "You want to make sure you have a solid policy in place that the medical staff leaders have reviewed, so if and when it comes up, you know how you are going to handle that [situation]."

For new medical staff leaders, make reviewing the policies and procedures a part of their leadership onboarding/training. Linda Van Winkle, CPMSM, CPCS, former director of medical staff services for CHRISTUS St. Patrick Hospital in Lake Charles, Louisiana, encourages MSPs to take their physician leaders to conferences every year and ensure they have a solid understanding of what their role is. She believes it is worth the time, energy, and expense to invest in physician leadership training so when the time comes for a corrective action or fair hearing, the physician leader will feel confident and supported in his or her role.

Medical staff leaders are also responsible for communicating egregious events to the board of directors, before board members find out through hearsay or a letter informing them the hospital is being sued by Dr. X. This can be difficult for some medical staff leaders because they feel loyal and protective toward the medical staff, Cox says. However, you will win more support from your board of directors as you go through the action if they are not blindsided by the events. Remember, the board has the ultimate accountability.

"You don't want your chairman of the board to get an indication that there is a challenge with a physician by reading it in the newspaper," says Cox. "The medical staff leadership and the chairman of the board need to sit down and discuss what actions are currently in play. The board should be your advocate."

Being a diplomat is another role for medical staff leaders during this time. Heather Fields, JD, CHC, a shareholder at Reinhart Boerner Van Deuren, s.c., in Milwaukee advises the CMO/VPMA or senior physician leader to engage in active diplomacy efforts to attempt informal resolution of a serious matter. Peer-to-peer communications play an instrumental role in avoiding the need for a fair hearing. Sometimes you need a colleague who can be the "voice of reason" for the aggrieved physician. Your chances of avoiding a fair hearing can hinge on having a negotiator who has some common ground with the affected physician. You need a person who can present the realities of the situation in a way that can be heard—that is, patient safety trumps all other competing concerns, including the privilege of being able to practice medicine.

However, this is not an easy role for many physician leaders. As Fields points out, most physicians did not become physicians to play the role of negotiator or diplomat, and many physician leaders never receive formal training on doing so. This goes back to the importance of MSPs ensuring that physician leaders receive training and support on a regular basis.

Van Winkle advises MSPs to use their influence when it comes time to elect new physician leaders. Before her medical staff nominating committee meetings each year, she would prepare a list of physicians she thought would make good leaders. Although she could not vote, nominating committee members would generally take her recommendations 75% - 80% of the time.

"Having a strong, respected complement of medical staff leaders was very important to me. I gave a lot of thought each year to which physicians should be brought into leadership roles," says Van Winkle. "At the time you are having a hearing is not the time you want to think about that. Start now to build a good group of physician leaders and keep those good leaders on important medical staff committees for as long as possible.”

Medical Staff Briefing, February 2015