Medical staff effectiveness: Third in a series

Dear Medical Staff Leader,

In the April 17, 2003, issue of Medical Staff Leader Connection, I defined a truly effective medical staff as one that successfully carries out those responsibilities that fall within its sphere of control while simultaneously expanding its sphere of influence. This week, I will define an effective medical staff using a somewhat different approach. This approach begins by recognizing the medical staff's role in ensuring and improving the quality of care provided at the hospital, which includes both the quality of individual physicians and the hospital's systems.

In regard to quality, the medical staff should control processes that directly affect its members' rights when the quality of a physician's individual performance and privileges are evaluated. In addition, the medical staff should have influence (but not control) over hospital processes that directly affect the quality of physicians' work life (e.g., processes that dictate how laboratory and imaging study results are reported to physicians, availability of appropriate instruments and capital equipment, information technology support that improves patient care such as bedside charting and computerized physician order entry, and adequate nurse staffing). The work of the medical staff, as it relates to these quality issues, may be understood as appropriate and effective physician advocacy.

Physician advocacy has been a long-standing goal of most organized medical staffs, but focusing on self-serving physician advocacy that does not improve patient care can reduce the medical staff's sphere of influence. However, physician advocacy that aims to improve patient care is the optimal strategy for expanding the medical staff's sphere of influence.

Keep in mind that physician advocacy, even in the name of quality patient care, must be balanced against another important medical staff responsibility--ensuring the success of the health care organization. Responsible physician leaders understand that the medical staff is accountable to the board, and that the board is responsible for overall organizational success. The activities of the medical staff and its leaders should aim to ensure this success. These activities can include efforts to comply with regulatory requirements (e.g., JCAHO, HIPAA, corporate compliance, and Stark). They also include activities that help the hospital manage expenses, grow market share, and recruit and retain qualified physicians and other hospital staff. In short, the medical staff should carry out the hospital's mission, vision, and strategic plan.

The tension or "polarity" of balancing physician advocacy and organizational success lies at the heart of the challenge of leading an effective medical staff. But when issues arise that relate to physician advocacy or organizational success, medical staff leaders should focus on those activities that will result in the highest quality of patient care, while keeping in mind that quality of care can't be divorced from cost issues. "Polarities" like these are all around us, and leaders must manage these polarities well to achieve a truly effective medical staff.

That's all for this week.

All the best,

Rick Sheff, MD