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Failure to tackle a difficult issue

Medical Staff Leader Connection, August 10, 2005

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Dear Medical Staff Leader:

"Continue to monitor," states the minutes of the surgical department meeting. "Tell the nursing supervisor to keep her eyes open," says the department chair. When a particular physician's name comes up yet again at the medical executive committee meeting, all eyes immediately began scanning the agenda and materials package. The performance improvement coordinator says to the chief of staff, "Dr. Smith, everybody knows but nobody acts. What are we waiting for?"

What can a board member, chief executive officer, vice president of medical affairs, intrepid medical staff leader do when everybody knows a physician's performance is not up to par but no one will act? If the medical staff is incapable of resolving the issue, management or the board must work with medical staff leaders to orchestrate an objective external evaluation of the quality and appropriateness of the practitioner's work.

The physician selected to conduct such a review should submit a report directly to the MEC that details his or her findings, conclusions, and recommendations. The MEC should analyze the report to develop its recommendations for consideration by the board.

As with most other medical staff issues, medical staff bylaws and policies should be followed under all circumstances and the affected practitioner must be given an opportunity to review any report that predicated recommendations for corrective action. Furthermore, the practitioner should be made "part of the solution." The physician should be informed that the staff or institution is concerned about the quality of services he or she provides to patients and that such concerns can only be resolved objectively through the use of external physician evaluators.

The physician should be given the opportunity to provide input into the external reviewer's qualifications and should be given the courtesy of reviewing and rebutting the report before the MEC recommends corrective action. However, the physician should not be permitted to prevent an objective external analysis, nor should he or she be present during the evaluation of his or her patient records.

The medical staff and board must perform difficult work in the interest of ensuring good patient care. If the medical staff fails to accept the responsibility for a investigating a physician's poor performance, responsibility for careful objective assessment and action to correct observed problems falls to the medical staff leadership and the board of directors.

That's all for this week!

All the best,

Hugh Greeley

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