Issue link: https://beckershealthcare.uberflip.com/i/806232
51 Executive Briefing sought to escape the administrative burdens associated with independent practice, accord- ing to The New England Journal of Medicine. "[Younger physicians] want to do what they went into medicine to do — take care of pa- tients — and then they want to go home be- cause they have lifestyle expectations out- side their job," Dr. Hoppa says. Young physicians who increasingly value work-life balance are less likely to attend medical staff meetings and functions sched- uled before or after working hours. The ab- sence of physicians during these meetings makes solving clinical problems and reach- ing quorum particularly difficult. III. Emphasis on outpatient care settings Increasingly today, there is a separation between clinicians supplying solely inpa- tient care (hospitalists) and their ambulato- ry counterparts. Many of these ambulatory providers become isolated from the hospital and their inpatient colleagues. Value-based care requires a high degree of clinical and administrative coordination be- tween caregivers. To achieve this, Dr. Hop- pa recommends medical staff consider how existing bylaws affect their ability to engage with and account for non-hospital provid- ers. For instance, changing staff voting rules, amendment processes or committees could help staff improve relationships between physicians and non-physicians, as well as col- leagues in alternative care settings. New opportunities in updating medical staff bylaws Medical staff bylaws must conform to federal and state legal regulations and requirements of certain accreditation groups. But medical staff organizations can also customize many bylaw items to reflect their specific organiza- tion's unique work culture, practices, demo- graphics and values. "Some people think there's a 'one-size-fits-all' model for bylaws," Dr. Hoppa says. "In reality, no two sets of medical staff bylaws are the same." Hospital and physician leaders may realize three major benefits from reviewing and up- dating their medical staff bylaws. I. Relieve medical staff of excessive demands Medical staffs are challenged to create an effective and efficient medical staff structure that relieves physicians of excessive adminis- trative or time-intensive tasks, Dr. Hoppa says. Reviewing and updating bylaws gives medi- cal staffs the opportunity to improve physician engagement by addressing outmoded lead- ership and management structures. Consider the fact that young physicians who value their free-time aren't motivated to attend meetings before or after work. Communication can, and should, occur in multiple venues and in man- ners other than meetings. Meetings should be reserved for substantive discussion and decision-making. This can lead to increased engagement because the clinician feels that his or her time is being valued. II. Improve ability to effect meaningful change. Restructuring the medical staff organization can also help improve the organization's re- sponsiveness. Bylaws written in the 1960s typically favored informal, voluntary leader- ship roles and consensus through super-ma- jority voting. This made organizations slow to implement change. Eliminating unnecessary committees, clearly defining physician leadership roles, vetting physician leaders and streamlining amendment processes can make medical staff organizations more responsive and capable of partnering with management to drive rapid change. III. Incorporate best practices Reviewing bylaws gives medical staff the op- portunity to incorporate best practices pro- moting high quality care in clinical workflow, Dr. Hoppa says. For instance, it is not required by the CMS Conditions of Participation to perform a criminal background check on a physician applying for privileges. But to improve the appropriate evaluation of clinicians applying for privileges, many medical staff organiza- tions have customized their bylaws to make criminal background checks a requirement during privileging. In another example, some medical teams are replacing traditional departmentalized man- agement structures with a broader service line approach. This broad approach helps mitigate the negative effects of working with isolated clinical departments, which may re- sist change when implementing continuous improvement programs. Best practices when updating medical staff bylaws Dr. Hoppa recommends three best practices for hospitals and medical staff leaders con- sidering updating their medical staff bylaws. Gain physician and administrator buy-in from the start. Getting physicians engaged in bylaws review is critical. Hospital and physician leaders can address physician apathy by showing physicians how by- laws redesign benefits their daily lives. "First, you have to overcome physicians' fear that the redesign process will be lengthy, boring and not worth the time spent — which is incorrect," Dr. Hoppa says. "Medical staff and hospital leaders can encourage physi- cian buy-in by educating practitioners about how healthcare is changing, and explaining why it's in their best interest to update bylaws to respond to today's challenges." It is also worthwhile to include legal coun- sel and hospital administrators in the review process. Involving local legal counsel and administrators early ensures nuanced legal requirements and hospital needs are satis- fied during bylaws revision. "The review process should include a wide variety of leaders and influential medical staff who can vet the issues before proposing a fi- nal version for approval by the medical staff," Dr. Hoppa says. This fosters transparency, trust and collaboration among stakeholders. Consider your resources. "First, an organization must decide if it has the appropriate knowl- edge and time to overhaul its medical staff bylaws by itself," Dr. Hoppa says. "We've found most hospitals administrative structures are fairly lean, meaning they don't have the people required to take on a significant administrative project like overhauling their bylaws." Hospitals lacking resources and medical staff expertise can benefit from involving outside consultants and subject matter experts to provide additional support. Utilize industry experts. Many consulting firms offer bylaws review and design sup- port. Since bylaws debate among physicians can get heated at times — like when discuss- ing board recertification requirements — Dr. Hoppa recommends organizations consider consultants who are physicians. "The Greeley Company believes 'by docs, for docs' is the best approach to bylaws rede- sign," Dr. Hoppa says. "Consultants who un- derstand the politics of physicians can help supplement the advice of legal counsel, and ensure physicians, administrators and law- yers are all happy with the final result." Conclusion Many of today's physicians understand that, like executive and community leaders, they must set aside self-interest if they wish to govern effectively. Providers' mission to de- liver high-quality care, ensure patient safety and offer excellent service at a significantly lower cost than in the past requires a medi- cal staff that is far more agile, responsive and adaptive. Updating medical staff bylaws to transform physician culture and staff organi- zation can help both hospitals and physicians create a framework that fosters teamwork and supports continual improvement. n The Greeley Company has an outstanding reputation for providing solutions through consulting, education, interim staffing, credentialing management, and external peer review to healthcare organizations nationwide. We focus on needs and challenges related to medical staff, governance & physician alignment; CMS compliance, accreditation & quality; and credentialing, privileging & provider enrollment.