How I wished I had been trained for the MEC

In the next eight days, we won’t only be counting down to a new year—many medical staffs will also be counting down to a new medical executive committee (MEC). Some medical staffs have created a succession planning process that exposes future MEC leaders to the nuances and complexity of medical staff governance. Some medical staffs even require new leaders to serve one or two years in a supportive role, such as president of the medical staff elect, prior to joining the MEC. Then there are the rest of us, who through our own naïve desire to be of service, had to learn through trial and error, with little—if any—formal training or mentoring.

The following is a list of what I wish I had been taught prior to becoming medical staff leader that would have saved me an enormous amount of frustration and self-doubt:

1. Medical staff roles and functions

What is an organized medical staff, anyway? When I became president of the medical staff years ago, I had no idea what I was leading or what its relationship was to our governing board. My CEO tactfully suggested that I read the bylaws, and I was astonished at what I didn’t know about my leadership role. Understanding the history of the organized medical staff, why it is a legal and accreditation requirement for healthcare organizations, the roles and responsibilities of MEC members, and the different medical staff/MEC models that are working (or not working) throughout the country, would have been invaluable.

2. Credentialing and privileging

When I first assumed a leadership role, I had no idea that credentialing and privileging were separate functions. Credentialing is about evaluating an applicant for membership on the medical staff, whereas privileging determines what a practitioner is permitted to do either as a member or non-member of the medical staff. I was also unaware that there were legal and accreditation requirements that every hospital needed to follow. It wasn’t long before I discovered many of the challenging political and economic issues that continually came up surrounding the credentialing and privileging processes, including:

• What do you do when a physician no longer actively practices at the hospital?
• How do you credential non-physicians who want to join the staff?
• How do you credential and privilege physicians requesting to use new technology and procedures?
• What do you do when other hospitals refuse to share useful information about an applicant?
• How do you handle an applicant with a history of disruption or impairment?
• How to you handle a request for a reference when a physician’s privileges have been under suspension?
   

Few things I learned in medical school prepared me for these challenges. Often, the CEO and legal counsel for the hospital knew little more than I. Having a solid grounding in this area would have been enormously beneficial and would have prevented numerous quality issues and legal concerns from occurring.

3. Physician performance measurement and management

When it came to quality, many of us were trained under the following school of thought: If you don’t hear anything bad, then the practitioner must be all right. It didn’t take long to realize that being in the dark regarding a practitioner’s shortcomings was more about luck than skill. Nobody taught me about proctoring to confirm competence for new privileges or for potential concerns raised; ongoing professional practice evaluation (OPPE) and focused professional practice evaluation (FPPE) weren’t on the books yet. Nobody showed me how to develop a performance feedback report or that peer review could be something positive and constructive. In short, I had no idea how to assess and measure physician performance.

4. Managing fair hearings and corrective action

Not so long ago, if a practitioner had a chronic performance or conduct issue, leaders typically reasoned, “There’s nothing we can do about it. That’s just the way Dr. X is.” It wasn’t until much later when I realized that we weren’t doing Dr. X any favors by letting his or her poor or marginal performance drag him or her (and everyone else) down.  However, learning to manage my colleagues’ chronic professional performance issues was not in my clinical acumen. In addition, our economic and political relationships on the medical staff made dealing with thorny professional issues daunting. Training in this area would have been of immeasurable benefit for both myself as a leader and the individuals who I could have helped.

5. Public accountability for quality

It is embarrassing when the public knows more about your medical staff’s and hospital’s performance that its leaders do. With legal, regulatory, accreditation, and commercial groups collecting healthcare data and publishing it on the Internet, it seems absurd that the medical staff and hospital leaders are not sharing this data with each other in constructive way. When I was president of the medical staff, medical staff leaders and hospital administrators spent time figuring out ways to hard wire core and Surgical Care Improvement Project (SCIP) measures into our quality indicators so that we could at least try to hit 100% of measures 100% of the time. We realized that if we left these processes to chance, the public would judge our overall quality by a few poorly managed indicators. We also realized that we were benefiting neither the hospital nor individual members of the staff by allowing ourselves to “fail” from a public reporting standpoint.

6. Patient safety and performance improvement

Until Institute of Medicine issued its report “To Err is Human” in 1999, most of us assumed that if we all did the best that we could, whatever happened to a patient was probably going to happen anyway. Now we know that failure to standardize best practices, eliminate bottlenecks and non-value-added variation, and find solutions to sentinel events may lead to significantly reducing avoidable errors and adverse outcomes. Having some training in patient safety and process improvement techniques, such as performing a root cause analysis or fostering a patient safety culture, would have made an incalculable difference for both the medical staff and our patients.

7. Legal and regulatory requirements

A client I was recently working with was cited by their state’s department of health because a misinformed public official thought that only physicians could determine if a woman was in the early stages of labor as a part of the medical screening exam under EMTALA (Emergency Medical Treatment and Active Labor Act). As a result, hospital management required obstetricians to come in every night for two years to do something that a nurse midwife or nurse practitioner could have done instead.  Having a working knowledge of EMTALA, Stark, Anti-kickback, CMS’ Conditions of Participation, and Joint Commission standards would have been invaluable to combat inadvertent misinformation that came from well meaning individuals in authoritative roles.

8. Healthcare finance

I remember asking financial questions in medical school and receiving questionable looks from my professors. Why on earth would I request information about such a mundane and demeaning topic? It wasn’t until I got out of training that I realized that a great deal of our schooling was not done with the vast majority of healthcare professionals in mind. Medicine is a healing art as well as a business. Not providing us with the fundamental language of business, namely “finance,” was short sighted. Learning to read a financial statement with the same alacrity as reading an EKG or chest X-ray was key to my understanding of the world of management and its relationship with medical staff. Helping our MEC members to learn this seemingly arcane language would have bridged innumerable misunderstandings between senior management and the medical staff and enabled us to reach mutually valued goals with greater efficiency.

9. Leadership skills

How do you manage change or deal with the inevitable conflicts that erupt on the medical staff? How do you mediate and arbitrate when two sides can’t reach an agreement? How do you run a meeting that people want to attend? It took years of trial and much error to apply basic tenets of human psychology to medical staff leadership. This turned out to be the most difficult and important part of my leadership role. Gaining some mastery years ago would have spared me and my colleagues countless episodes of regret and embarrassment.

10. Future trends for medical staffs and hospitals

Who prepared us for a world of hospitalists and non-hospital-based practitioners? Who taught us how to lead physicians and other healthcare professionals in a healthcare network 100 miles away? Who prepared us for a paperless electronic world? Most of us struggled to learn these lessons and could have benefited from those who foresaw these changes and could have enabled us to make our leadership a little less uncertain.

We cannot go back in time, but we can make a resolution to make life better for current and future leaders who struggle with the same issues that we struggled with. How? By giving the next generation of healers a little more wisdom and knowledge through systematic training prior to and during their leadership tenure, we can ensure that our profession will continue to evolve and improve over this and many future new years.

Jon Burroughs, MD, MBA, CMSL, is a senior consultant with The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.

The Greeley Company provides customized onsite educational programs to help you educate your new MEC members and other medical staff leaders. To speak with a client relations representative about how to take advantage of this unique educational opportunity, please call Robin Flynn at 888/749-3054, ext. 3249 or e-mail rflynn@greeley.com.