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Five dynamic tensions in contemporary medical staffs part 5: Stability and change

Medical Staff Leader Connection, September 3, 2008

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As we noted at the start of this series, the five dynamic tensions in contemporary medical staffs are:

1. Collegiality and excellence
2. Freedom and commitment
3. Appropriate independence and mutual accountability
4. Appreciation and continuous performance improvement
5. Stability and change

If medical staff leaders are to fulfill their dual responsibilities of helping the hospital and physicians succeed, they must embrace and implement change. For today’s medical staffs, such changes are likely to include:

• Adopting evidence-based medicine to insure optimal patient care
• Addressing disruptive physician behavior to insure a safe and effective working environment
• Operating under public scrutiny concerning quality measures and the cost of patient care
• Adapting to new technologies, including electronic record keeping and computerized physician order entry systems
• Managing physician-to-physician and physician-hospital conflicts of interest in thoughtful ways to simultaneously support physicians and the hospital

The very survival of hospitals and their medical staffs depends on their ability to respond to these changes in a timely and effective manner. Yet any organization requires a measure of stability, or it risks lurching from one fad to the next. The upside of change is new energy; the downside is chaos. The upside of stability is consistency; the downside is stagnation. Thus, an effective medical staff is one that balances stability and change well.

Medicine is inherently a conservative profession. Physicians  know that patients depend on them every day, and they don’t want their patients to fall victim to fads and unproven treatments. At the same time, physicians don’t want to do anything that undermines a peer’s ability to earn a living and thus hesitate to offer each other tips for improvement or suggestions for change. This conservatism has served patients well in some ways, but not in others. Excessively slow adoption of evidence-based best practices can lead to unnecessary patient harm.

How does your medical staff balance stability and change? Are you able to realize the benefits and downsides of both?

In next month’s conclusion to this series,  I will discuss several strategies medical staff leaders can use to create balance and harmony within the medical staff.

William K. Cors, MD, MMM, FACPE, CMSL
Vice President Medical Staff Services
The Greeley Company

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