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Flashpoints in the Medical Staff World Horty, Springer & - - PDF document
Flashpoints in the Medical Staff World Horty, Springer & - - PDF document
Flashpoints in the Medical Staff World Flashpoints in the Medical Staff World Horty, Springer & Mattern Philosophy that underlies all that follows: 1 Flashpoints in the Medical Staff World When physician leadership is as good as it can
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Articulate High Standards. Shout Them from the Rooftops. Measure compliance; “publish” results.
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Intervene early. Make the problem part of the solution.
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Have good policies. Follow them.
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Making the Medical Staff Meaningful
Does your medical staff delight?
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How do we get physicians to participate in the medical staff?
?
Wrong question. Better question: What can the medical staff do to bring value to the life/practice of physicians – across the continuum?
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Collegial environment critical to joy in profession. Picture of joy is not a selfie.
(Some speculate that a contributor to the high physician suicide rate is increasing isolation.)
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American Foundation for Suicide Prevention (2014)
300-400 physicians per year.
Major Risk Factors
- Depression
- Bipolar
- Alcohol/substance abuse
No evidence that work-related stressors linked to elevated physician rates.
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- Medical students: 15-30% higher than
general population
- Male physicians: 70% higher than
males in other professions
- Female physicians: 250-400% higher
than females in other professions
Medical staff must create support for its membership in many arenas: Celebrate! Start each meeting with a joyful patient story. You have many.
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Remember why you do what you do.
Why did you choose health care?
- To please a parent?
- Passion for science?
- A doctor you admired?
- Money?
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Health care chose you. Make meetings matter.
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Attending meetings should contribute to growth as a physician. Use case studies.
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Formal and Informal Meetings That Matter
- Well planned
- Substantive
- Safe educational programs – starting with
- rientation:
- The Board and what it does
- Administration
- Support staff
- Preceptoring (buddy program)
Formal and Informal Meetings That Matter
- Expanded role of Wellness Committee
- Consultation without stigma
- Publicize its role
- Facilitate consultations
- Communicate in myriad ways
- Require members to access available
information
- Informal, supportive, short get-togethers
- Hotlines for news and concerns
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Formal and Informal Meetings That Matter
- Food is love: meet in cafeteria or physician
lounge each Tuesday at 6:00 a.m. or 11:00 a.m. for all who can make it
- Congressional dining room and the demise
- f collegiality
- Be the go-to source for information,
assistance (like the Rapid Response Team that is available to help with EMR)
What will work for you?
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Leadership Development
- Recruiting, grooming your successors
- Leaders “self-select” (with
appropriate encouragement)
- True leadership – visionary, quality-
driven
- Medical Staff [physician leadership]
college
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- Someone told you:
- “You’d be great at….” or
- “Your skills would really move this
project….” or
- “You are so well-respected by your
peers, you’d make a terrific.…” or
- “Please help me out by reviewing
these cases and.…”
Introduce new leaders with small “wins.”
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Celebrate/reward good work Thanks.
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Eliminate Litigation
- Define Standard of Care
- Create Expectations
- Education/Compliance/Enforcement
- Assessment of high-risk practices
− Quality − Risk − Training − Documentation − Practice processes − Environmental hazards
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But, bad things happen.
- Investigate
- Disclose
- Apologize (Sorry laws)
- Remediate
What Is Cause of Litigation?
- Bad outcome
- Injury
- Anger
- Sense of unfairness
- Vengeance
- Patient/family wants to know
what happened (cases withdrawn at conclusion of discovery)
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PHTS Experience
- A. Steps:
- 1. Prompt reporting of incidents
- 2. Prompt investigation, including
interviews
- 3. Preserving records
- 4. Meet with injured party/family
- 5. Discuss facts openly
- 6. Offer remuneration commensurate
with injury
PHTS Experience
- B. Results:
- 1. Financial savings – 66% ($8 million
from mid-2012 to mid-2014)
- 2. EVERY SINGLE INCIDENT
avoided litigation
- 3. Average cost of early resolution
case: $16,000
- 4. Average cost of one “progressing
to lawsuit status”: $143,000
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Human benefits, too:
- Sterile pack case
- Picasso
Creative ED Call Solutions
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DO NOT try to solve call problem one specialty at a time. Multidisciplinary task force designs solutions.
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Build fair call into all employment contracts. Create and market alternative multi-hour site for non-emergent care; permit immediate triage and transfer.
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ED directs all patients to hospitalists. Is this legal? ED contract (and bylaws) authorizes ED physician to admit to service of
- n-call physician.
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Deferred compensation.
Old Is The New Useful
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“It is time.” Dignity in identifying and communicating with the aging practitioner.
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The Ultimate Balancing Act
- Protect patients
- Protect the practitioner
- Protect other practitioners
- Protect the organization
- Comply with accreditation standards
- Comply with Age Discrimination in
Employment Act (ADEA)
- Comply with Americans with
Disabilities Act (ADA)
Options
- Provision in Credentials
Policy/Bylaws for “Practitioners Over Age ______”
- Late Career Practitioner Policy
- Peer Review Policy
- Practitioner Health Policy
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Practitioner Health Policy
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Medical Staffs should evaluate their unique culture and decide if an age-based rule makes sense in their hospital. Benefits of a Rule
(e.g., a Bylaws Provision)
- Protect patients
- Reduce risk of negligent credentialing
claims
- Treat all physicians the same (thus
reducing risk of discrimination claims)
- Depersonalize issue
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Rule
- One-year appointments
- Age-based expiration
- Required evaluation
- Required CME
- MOC
Drawbacks of a Rule
- Overly inclusive
(affects physicians with no problems)
- Controversial and inconvenient
- Unnecessary if peer review process is
working properly?
- Difficulty interpreting test results
(especially if no baseline)
- Increased risk of discrimination claims
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Low Risk
- Adopt and enforce evidence-based
volume requirements for procedures for all physicians
- Concurrent chart review of certain
number of cases after age “x”
- Annual reappointment
- Concurrent proctoring of certain
number of cases
Some Risk
- Require physician to have assistant
at surgery or back-up immediately available
- Comprehensive physical and
psychological evaluations
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Do These Exams Yield Useful Information?
- If no baseline to compare to, what
do results mean?
- Even if decline noted, at what level
is it significant?
- BUT – exams can be viewed as
flagging mechanism for focused review of practice and outcomes
High Risk
Automatic loss of privileges after a certain age.
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Age Discrimination in Employment Act (ADEA)
- Applies to “employees”
(though some courts are interpreting broadly) over 40
- Prohibits employment action based
- n age
- Applies to mandatory retirement,
mandatory testing, etc.
Can an aging policy treat all physicians the same (e.g., internists and surgeons)?
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Joint Commission Standard MS 11.01.01
Hospitals must have a process to address: − Education about impairment − Self-referral and referral from others − Confidentiality
Joint Commission Standard MS 11.01.01
Hospitals must have a process to address:
- Evaluation of credibility of complaint
- Monitoring
- Reporting when practitioner is
providing unsafe treatment
- Appropriate action
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Process
- Education
- Reporting
- Fact-finding
- Meeting
- Evaluation
- Resolution
- Follow-up
Education
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- Signs and symptoms of impairment
- Importance of reporting
- Downside of “enabling”
Policy should address: Education Reporting
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Who should staff report concern to?
- A. Practitioner Health Committee.
- B. Leadership Council.
- C. Credentials Committee.
- D. Medical Executive Committee.
- E. It depends.
- Emphasize confidentiality
- Describe process for reporting by
- thers
- Encourage voluntary self-reporting
Policy should:
Reporting
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- Interview staff
- Review relevant documents
Fact-Finding Is there enough evidence to meet with Legend?
- A. Absolutely, YES!
- B. Absolutely, NO!
- C. It depends on whether there have
been other episodes of confusion.
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Wrong Question!
You don’t need “evidence” or “proof” to meet with a physician. Plan the Meeting with Care
- Don’t shoot from the hip
- Have a game plan (and an end plan)
- Review your documents – know
your own process!
- Know your options
Meeting
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Plan the Meeting with Care
- Anticipate denial
- Emphasize confidentiality
Meeting
- Practitioner Health Committee
should select evaluating entity
- Evaluation is NOT quick visit
- Have evaluator complete form that
addresses relevant issues
Evaluation
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- Legend should sign authorization
permitting hospital and evaluating entity to communicate with one another and share information
Evaluation Conditions of reinstatement should be described in detail. Resolution
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Balancing Act
- Protect patients
- Protect practitioner
- Protect organization