Devoción al Sagrado Corazón y festividad de Cristo Rey

Going back in time, the governance of the _​medical staff was a little different. Before the 1950’s, medical management first started as a group of doctors and surgeons working in a hospital together that would provide medical services, who would meet monthly, and _​peer review_​ each other. The Joint Commission on Accreditation of Healthcare Organizations started to require peer reviews at all United State hospitals in 1952. However, in 1986 there was economic abuse of the peer review process, which led to physicians fearing possible consequences of peer reviews due to a court ruling. In 1986 the HealthCare Quality Improvement Act was put in place by the U.S Congress to make it clear that

peer reviews are for physician quality improvement (Vyas, Hozain, 2014).

The medical staff is an extremely traditional structure, “It has a proud and rich legacy but now must change or become obsolete (Burroughs, 2015).” In 1919, “Minimum Standard

Document,” was a set of principles created by the American College of Surgeons. This set of principles took six years to come together with the work of Ernest Amory Codman, and the ACS’s Committee on Standardization. The medical staff was defined as “a group of doctors who

practice in the hospitals inclusive of all groups (Burroughs, 2015).” The medical staff was like a membership, which was strictly made of physicians and surgeons who were trained and licensed. These physicians and surgeons had to be capable in their field and have good character with professional ethics. The “Minimum Standard Document,” asked that the members follow all rules, regulations and policies that the hospital asks. These include, regular monthly meetings, analysis of care provided, complete accurate records, and supervised diagnostic and therapeutic facilities (Burroughs, 2015).” The Joint Commission on Accreditation of Hospitals (now The Joint Commision) was founded in 1951 with the help of the ACS due to their successful medical staff model. The Health Care Financing Administration mandated the concept of the organized medical staff was going to be used for healthcare to receive payments from the federal

government for the healthcare services. The classic organized medical staff has the skill to manage peer evaluations,_​ credentialing and privileging_​ as will as the quality mistake function. Today, medical staffs are frequently split between those peers that understand the need for interdependence and those who don’t, creating a difficult, bitter environment. Physicians typically have a difficult time adapting to change that they do not see necessary. There needs to be a balance when it comes to change that supports physician interests and transforming their care at a high quality with a low cost. (Burroughs, 2015).

As time goes on, physicians start moving away from hospitals and start gravitating towards healthcare organizations and other healthcare services. Since physicians are venturing off from hospitals, the classic medical staff structure starts to become irrelevant. Since older physicians want to work long hours and are very traditional they followed that structure of the medical staff. The younger physicians do not want to attend any staff meetings or functions because they aren’t interested in working long hours or attend this meetings on their own time. The resigned medical staff should include changes to its leadership model, operational process, organization structure and the relationship between the staff and management. To start with the new medical staff model there needs to be a physician leadership group that is stable and accountable. All physicians that would like to be a part of the leadership group will have to complete leadership training. In this training the physicians will learn the medical staff structure and purpose, credentialing and culture, peer review and performance, legal and financial

obligations, and lastly performance improvement, patient safety and leadership skills. After the physicians are trained they should continue to have coaching to help with transitions. Physician leadership used to be strictly volunteers that did not receive any compensation for their roles. Now this is shifting to these physician leaders being compensated in these positions. The physicians are now being compensated for having more responsibilities with the role. Some of these responsibilities include but are not limited to, preparation and commitment to the medical staff structure, being held to performance expectations, and meeting and exceeding the ROI standards. (Burroughs, 2015).

The next step of the medical staff structure is to reorganize the structure. In doing so the structure has to be vital, responsive and has to partner with the management department in order

to have effective change. It would be ideal to have a small Medical Executive Committee (MEC) that includes physicians and leaders from the hospital as well as the ambulatory department. These members of the committee will have the role of being representing best interests to all of the medical staff. The new medical staff structure should also include a credentialing committee and peer review committee. By having these committees there is more transparency, because those peers work specifically with the committee. When the departmental committee ran the peer review there were conflicts of interest. The next implementation is service line leadership, which typically follows a triad model, including a physician leader, an admin nursing manager and an executive leader. In such a service line the reporting relationships do not need to linear, there are services and departments that could be involved in a service line. (Burroughs, 2015).

Since the medical staff structure is changing over time, the new model still needs to remain successful. In order to have a successful medical staff the organization needs to have a shared mission, vision and strategy. All physicians should have an agreement with the

organization that has the medical staff bylaws and performance expectations, incentives, benefits, and compensation plan. With this agreement the relationship between the physicians and managers are legally, clinically and economically interdependent. It is possible that the medical staff structure will continue to gradually change over time since the structure has already changed since 1919. (Burroughs, 2015).

Knowledge Check #2

What was the medical staff defined as in 1919?

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