Bylaws and governance monthly: Don't wait for healthcare reform to kick in before improving medical staff processes

With all the controversy over healthcare reform, medical staff leaders may be thinking, “Shouldn’t we just wait until something is finalized before changing our bylaws, improving our peer review process, and looking at our credentialing procedures?” The answer to that question is a resounding “Absolutely not.”

No one knows for sure what healthcare reforms may be enacted—if any—but there is one thing we do know: Whatever the future holds, regulators will place increased emphasis on transparency and accountability.

Regulators, payors, and the general public are already scrutinizing physicians and hospitals regarding the quality and cost of our healthcare system.  That makes it imperative that we have the best systems in place to show that we are doing the right things for our patients in the most effective way possible.

Now is the time to get started on the improvement process by re-examining everything from patient care to the medical staff’s governing process to ensure that it is both effective and efficient.

One great place to start evaluating effectiveness is with the credentialing and peer review processes – getting the right people on your medical staff and ensuring their performance remains up to your own internal standards. Then we need to look at efficiency—When  was the last time your medical staff looked at the total volume of data that it collects and asks, “Why are we doing all of this?” 

We need to gather data for reporting purposes (i.e., regulators, payors, etc.) and for internal assessment and improvement purposes, which include competency assessment of practitioners and process improvement initiatives. If you’re gathering information that is not being reported externally or used internally for any constructive purpose, why are you gathering it? If your answer is “That is what we have always done,” then it is time to evaluate whether you are using physician time, staff time, technology, and other resources wisely.

In addition to credentialing and peer review processes, medical staffs need to look at the administrative bureaucracies that have most likely been in place for many years and question whether those bureaucracies serve us well today. For example, medical staffs in the past responded to regulators’ calls for medical staff participation in or oversight over various functions by creating numerous committees. However, many of those committees today are poorly attended because they don’t address the true needs of our medical staff members. Think of how you can restructure the medical staff to use valuable physician time more wisely. You don’t need to work harder, just smarter.

As you make these changes to improve quality and value physicians’ time, remember that form follows function. Look at your bylaws, rules and regulations, and policies and procedures to ensure that you are doing what our documents say you are going to do. If you’re not, change the documents accordingly.

Continuously improving processes to improve the quality of care is simply the right thing to do, but it will also allow organizations to position themselves to compete effectively on quality and financial measures as we move forward in an era of increasing accountability and transparency – no matter what changes may occur in our healthcare system.

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