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A Pilgrim Legacy

Medical Staff Affairs Monthly, November 12, 2008

Thanksgiving is rapidly approaching, and the story of the Mayflower voyage naturally comes to mind. This story is recounted in Nathaniel Philbrick's Mayflower: A Story of Community, Courage, and War. About half of the Mayflower voyagers were Leideners (Pilgrims), a group united by powerful and long-standing bonds based on deeply held common values and beliefs in the profession of their faith. What they lacked was access to capital, management skills, and operational experience. The "Strangers" were the other half of the passengers. What this group lacked in profession was more than made up by their managerial and financial skills. The two groups had many differences but were united in the basic goal of trying to create a new and better community and way of life in a new world that would benefit all of the citizens.

As the Mayflower sailed off the barren and forbidding coast of present-day Cape Cod (hard to imagine by today's reality), the voyagers likely felt fear in their hearts as they ventured together into uncharted seas and lands not yet defined. It became apparent that the only way for the settlement to succeed was for everyone to work together collaboratively, despite many inherent differences. The strengths of both groups were needed to define the future. To their credit, these early travelers developed and signed a formal and binding agreement. It captured what each group needed of the other to succeed and set expectations and commitments to guide their future course. The resulting document has come to be known as the Mayflower Compact.

In an analogous fashion, the concept of the Mayflower Compact can serve as a model for physicians and hospitals to emulate as a starting point in their new journey to formalizing a commitment to improving relations as the old social contract between physicians and hospitals expires and a new one, as yet still unclear, awaits us. A compact, very simply, is an agreement or covenant between two or more parties. The covenant is a written agreement, under seal, between the parties for the performance of some action. The development of a compact—a written covenant—between the medical staff and the hospital can be a powerful tool to discuss, develop, and codify mutual expectations. Such a compact could include expectations that each party will:

• Search for common ground, while respecting legitimate differences
• Support the creation and development of each group's strategic goals
• Use facilitated, safe dialogue to articulate and advance clinical priorities
• Resolve to solve conflicts collaboratively when possible and to effectively manage differences and polarities when necessary
• Recognize the need to have fair and just mechanisms for the resolution of such conflicts and polarities as may arise.

A powerful starting point is to look at the respective mission statements of the medical staff and the hospital. The medical staff mission statement might call for ensuring that individuals granted privileges provide the best quality of care and that the medical staff is mutually accountable for that care. The hospital mission statement might address providing patient-centered quality care to the community or region it serves.

The hospital-medical staff compact might then include the following statement: "There is a mutual interest in providing better and expanding clinical care and programs to all of our patients and our respective communities."

Using this goal as a starting point, the physicians and hospitals can codify other expectations in the compact, such as the following:

• Physicians expect the hospital to provide quality staffing and timely, excellent support services, and the hospital expects physicians to be effective in holding each other accountable for care delivered by individuals granted privileges
• Mutually beneficial clinical and business ventures will be explored on a right of first refusal basis
• Fair and just processes will be developed to handle conflict, disagreement, and violations of the compact.

The use of a compact is an effective tool for the alignment and advancement of hospitals and medical staffs in their mutual interest of providing better and expanding clinical care to patients and communities. Apply the principle of keeping the end in mind, and envision the power that such a compact might have in your organization on aligning diverse interests and ensuring success for both the physicians and the hospital.

Until next time, have a safe and happy Thanksgiving!

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

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