As healthcare reform is advancing to new dimensions, it is necessary for the traditional medical staff model to move towards accountability, rather than rely on conventional autonomy.  Jon Burroughs discusses this need in his recent book “Redesign the Medical Staff Model: A Guide to Collaborative Change.”  The traditional medical staff model has served as a way to provide physicians with a culture that allows them to share facts and details with each other in a safe, protected environment.  These groups often consist of voluntary leaders, some with political influence.  This type of social construct centers on autonomy.

Today, these staffs are often split between those who desire a need for interdependence and those who do not.  Some physicians have a difficult time embracing change because they view it as a threat to their professional identity or that they are forced into “cookie cutter medicine”, yet a balance needs to be established between physician interests and transforming care delivery so the highest quality healthcare can be offered at the lowest cost.

As physicians tend to move away from hospital environments and into healthcare organizations, this traditional medical staff model becomes unnecessary as it loses its ability to manage a hospital-physician relationship.  A more modernized perspective is essential to transcend beyond the traditional hospitalized patients – addressing the directive to provide high quality patient care.  The move towards outpatient care delivery further suggests the need to do away with the traditional medical staff structure.

Healthcare is moving its focus towards a new value-based reimbursement system.  This requires a redesigned medical staff that demands a sacrifice of self-interest for a collective purpose.  Burroughs has some ideas of what this redesigned medical staff should like, focused around balanced accountability:

The four areas that demand attention for this new medical staff model are Leadership, Structure, Processes, and the Staff-Management Relationship:

Redesigned Leadership –

Physicians should be led by other physicians.  Having an accountable physician group makes it possible to establish a succession planning committee to develop criteria for leadership positions and support these new leaders during their term in a specific role.  It is also important for physicians to be groomed with professional leadership training skills to adequately learn how to manage and lead their staff by attending leadership seminar programs.  Because leadership requires more preparation and commitment than before, physician leadership is now shifting to a compensated position, where they will be held accountable for achieving measurable strategic goals.

Redesigned Structure –  

By establishing various committees, the new medical staff structure will be able to partner more easily with management to promote change.  A Medical Executive Committee (MEC) made up of physician leaders, hospital/ambulatory physicians, optometrists, chiropractors, and other non-physician clinicians can serve to represent goals and objectives of medical staff and strategize for team development.  A Credentials Committee focuses on policies and procedures, and accreditation aspects of credentialing and privileging.  They would be accountable to the MEC for the quality and integrity of their recommendations.  Designing a Peer Review Committee would help improve quality among medical staffs and shed light on issues that may otherwise be overlooked, like nursing or systemic issues.  Moving away from a traditional clinical department to a service line approach is important to oversee and improve clinical care, daily operations, and a unit’s financial performance.  Lastly, having an integrated medical staff – aligned with the same vision, mission and strategy – is necessary so everyone is in agreement and can rely on each other for achieving mutual goals.

Redesigned Processes –

It is important to address issues of potential conflict when transforming processes used by the medical staff.  Creating a conflict resolution procedure may be ideal for resolving problems that may arise as multiple methods will converge as ideas will be integrated into this new model.  Having meetings only when absolutely necessary is a must so physicians do not waste time away from patients or lose money by attending meetings where their presence is not needed.  Finally, in a pay-for-value world, it is essential to maintain a high quality physician staff.

Redesigned Medical Staff-Management Relationship –

Overall, it is clear that physicians will need to work together with managers and board members to improve quality, lower financial costs, and create a collaborative work environment among employees.  By allowing physicians to serve in leadership positions on governing boards, committees, senior management teams, and operating boards, new perspectives will be presented to upper-level management and boards of directors.  A channel of communication between these executives and medical staffs will exist, allowing for medical staff’s goals and objectives to be heard and, ideally, met.

Because the Patient Protection and Affordable Care Act instruct high quality treatment at a significantly lower cost than in the past, medical staffs must become more adaptive and be transformed into a structure that will accommodate for these regulations.  It requires team work from physician leaders and managers alike to establish an environment that can handle change quickly and efficiently, all while maintaining organization and balance.