Despite many hard-fought victories at hospitals across the nation and despite recent California law supporting medical staff efforts, the struggle to establish the proper role of physicians in assuring the quality and safety of patient care in hospitals continues unabated.
Since the early 1980s, I have witnessed the battle through my participation in the California Medical Association Organized Medical Staff Section and the American Medical Association OMSS in various leadership positions. Further, I am currently chief of staff for White Memorial Medical Center in Los Angeles--my second two-year term separated by a decade.
Given my ground-floor involvement, I would like to reinforce what's required on a practical level for medical staffs to effectively meet their obligation to patients and to their hospital governing boards.
First, all members of the medical staff must be consciously involved in and careful about selecting leaders. The medical staff must pick its best. Any conflicts of interest must be openly known and acknowledged. The leaders must have excellent clinical skills and be engaged in daily patient care at the hospital. A staff cannot afford to be led by someone who is uncommitted to quality, who will allow his or her personal interests to take precedence over the interests of the medical staff, or who sees the job as ceremonial. The succession of officers must be carefully considered, and those on the "ladder" who will not represent the medical staff and patients well should be removed--even when removal is uncomfortable.
The medical staff office and the officers need to be sufficiently funded to do their critically important work. Officers must be compensated adequately from medical staff funds for the heavy demand on their time, and the rest of the medical staff needs to support them on committees and in their departments. The hospital governing board needs to fund the medical staff office at a level commensurate with the importance of its work.
Medical staff leaders need to be directly involved in all measures related to patient safety and quality of care, as hospitals look to establish best practices, electronic medical records and public reporting of clinical outcomes. In our absence, steps will be taken that are not grounded in clinical reality and are ultimately less effective.
Medical staff leaders need to take very seriously their core functions of peer review, credentialing and delineating privileges. These functions profoundly affect the quality of care. Our knowledge, training and expertise are essential for their proper execution. We are the people who should be carrying out these functions, which is why the governing board and everyone else in the hospital rightly looks to us to be conscientious.
Medical staff leaders need to be educated on a broad range of legal, legislative, regulatory and process issues. We don't operate in a vacuum. That's where OMSS involvement has proven so valuable. The CMA and AMA groups are both excellent sources of information. The article on the next page, by Elizabeth "Libby" Snelson, Esq., covers the variety of services available. The CMA Model Medical Staff Bylaws provide a template to guide medical staffs in fully realizing their duties. CMA On-Call documents at www.cmanet.org offer sound legal advice on medical staff self-governance, economic credentialing, peer review and more. A CMA subsidiary, the Institute for Medical Quality (www.imq.org) holds excellent meetings covering current medical staff topics. Outside organized medicine, the Institute for Healthcare Improvement (www.ihi.org) offers important programs on patient safety.
The hospital governing board is responsible for the proper functioning of the hospital. The board delegates responsibility for safety and quality of care to the medical staff in recognition of the medical staff's knowledge, training, expertise and inherent ethical obligation to patients. The medical staff bylaws document the relationship between the medical staff and the governing board. By joining the medical staff, we agree, one and all, to live up to our obligation under the bylaws, to provide the best and safest care possible to patients. By understanding the relationship and the obligation we have, and by actively and aggressively pursuing our role, we improve care, protect patients, strengthen the hospitals where we practice, and enhance our capacity to effect change in our communities--for the better.
