Q&A: Medical staff bylaws for multi-hospital systems

Q: We are a system of multiple hospitals, and each has its own medical staff bylaws. Is it advisable to allow individual hospital medical staff policies if our organization is trying to develop consistency across all hospitals? Or is it acceptable and recommended to have separate bylaws, but incorporate medical staff policies for consistency?

A: There are a couple of issues here. Certainly, you could unify some of your medical staffs. Unifying them into one huge medical staff probably wouldn't make sense because my guess is your system covers a pretty broad geography. But there may be some clustering of medical staffs where it would make sense to unify them and allow them to work with a common set of medical staff bylaws.

With regard to policies, it certainly makes sense at the system level to vet some real best practices and implement them through adoption of some policies that will be uniformly applied to all of your medical staffs. But it's always important to recognize that there are local cultures and local differences in practice, and local differences in the constellation of available resources, that would warrant some uniqueness in policies or justify specific "local flavor" in the policies.

The goal should be to create system-ness in policies where it actually yields value—where unique local issues yield value, then we want to preserve these local characteristics and preserve the ability to have some local control over policies. Increasingly, there are best practices that ought to be reflected across all of a system's institutions. If your goal is to reduce variance across your institutions, uniformity of policy and approach makes a lot of sense.

The other question is, do you want to create some structures across your various medical staffs to provide a forum to reach consensus on those systemwide policies and procedures. That's generally wise, rather than simply handing policies down from on high. However, creating these structures can be a complicated task.

- Todd Sagin, MD, JD, from the webcast Medical Staff Governance Documents: The Increasing Importance of Contemporary Bylaws. To order this presentation on demand, click here.