The split vote

Dear Medical Staff Leader:

Most issues brought before the medical executive committee (MEC) are easily discussed and acted on. Votes are often simply dispensed with or taken as a formality. However, occasionally a contentious issue is brought before the MEC that, after seemingly interminable discussion, results in a split vote. For example, seven votes to six votes with the chair casting the deciding vote.
 
Medical staff leaders must consider the implications when the MEC resolves an issue in such a manner. A split vote puts the hospital's board in a very difficult position and will likely prompt the board to request a joint conference with medical staff leaders or send the issue back for further discussion by the MEC. A knowledgeable board will rarely take final action if the MEC is divided. In addition, if the MEC is making a recommendation to the general staff, a split votes invites a long, contentious debate and demonstrates the MEC's lack of decisiveness.
 
There are a number of actions or steps that a wise chief of staff might take to avoid such situations.
 
First, always review the MEC agenda in advance to identify such issues and ensure that the issue has been well vetted by multiple committees or departments before it is presented to the MEC for consideration.  If it appears that a department is "punting" to the MEC, the issue should be submitted to a special ad hoc committee for discussion and advice. The chair should notify the MEC of this action. (The chair controls the agenda.)

Second, if discussions at the MEC are difficult and a split vote seems imminent, use your position as chair to educate the committee about the dilemma faced by the board and indicate that the MEC's job is to avoid such situations.
 
Three, engineer a short break and permit all players to cool down prior to resuming discussion. Attempt to avoid the "quiet vote" (a vote cast by a member who has not participated actively in the discussion). Request input from each MEC member.
 
Fourth, use index cards to get a sense of the group's direction. Distribute one to each member and ask him or her to indicate their position-- pro or con. Review the results quickly and let the group know that you are not close to consensus on the issue. If a consensus is not forthcoming, suggest that the issue be tabled for discussion by a subcommittee of the MEC.
 
In essence, take any steps necessary to avoid such split votes for they are the seeds of future medical staff disharmony.

That's all for this week.

All the best,

Hugh Greeley
http://www.greeley.com/seminars