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Managing polarities in medical staff culture

Medical Staff Leader Connection, August 29, 2006

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Arguably, culture drives behavior and behavior drives results. Therefore, to achieve a truly effective medical staff, physician leaders must proactively mold and lead the medical staff culture so that it simultaneously drives the desired results of physician success and hospital success.

Recent literature addressing organizational culture has recognized that effective cultures must simultaneously embrace and balance interdependent opposites sometimes called polarities. The primary polarities that must be optimized to achieve medical staff effectiveness include the following:

Collegiality and excellence: Prioritizing collegiality too highly - that is, greasing the social wheels in our medical staffs - prevents physicians from holding each other to a level of excellence. An effective medical staff must support and expect both collegiality and excellence form all physicians.

Freedom and commitment: Each physician is autonomous and free to make choices as they see fit. However, a democratically organized medical staff depends on voluntary activities from medical staff members to participate in these activities. If this minimal level of commitment is not present, then the organized medical staff cannot carry out its activities effectively.

Appropriate independence and mutual accountability: Appropriate physician autonomy is an absolute requirement for physicians to exercise their clinical judgment and skills in the best interest of patient care. However, physicians are accountable to the governing board for all of their activities and actions within the hospital. This accountability is exercised through the democratically self-organized medical staff, and thus all physicians on the medical staff are mutually accountable to each other for the quality of care they provide.

Appreciation and continuous performance improvement: Physicians have often resisted efforts at continuous performance improvement if it means changing the way they practice medicine. A prerequisite for physician leaders in establishing a culture of continuous performance improvement is expressing respect and appreciation for the quality of care and the personal commitment and sacrifices already manifested by physicians on the medical staff. When physicians feel appreciated, they are much more likely to accept constructive feedback and improve their care over time.

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