EMPLOY A MORE AGGRESSIVE APPROACH
Organizations can aggressively take
on the oversight of clinical quality by
hiring chief medical officers, running
the medical staff office, and ensuring
that enough qualified staff are
available to operationalize
performance improvement efforts.
Most physicians now spend little
time at the hospital, doing the bulk of
their work in the ambulatory
environment. In addition, many
physicians in urban and suburban
markets are members of multiple
medical staffs, which explains why
the organized medical staff finds it
difficult to carry out its delegated role
for quality oversight. Although
physicians are concerned about the
quality of care that each of their
patients receive, they are generally
disinterested in hospital quality
initiatives and feel that the national
effort to promote quality care
overstates the problem and will not
be beneficial (VHA 2002). Therefore,
left to their own devices, medical
staffs are not likely to mount any
significant quality improvement
efforts.
RESTRUCTURE RELATIONSHIPS Hospitals
must be diligent in determining who
is appointed to their medical staffs;
must ensure that practitioners are
32 | LEADING A PATIENT- SAFE ORGANIZATION
up-to-date in their practices; and
must supervise all care rendered
within the organization, including
services provided by physicians.
Marren and his colleagues (2003)
suggest the structural silos (medical
staff and management) that exist
within the modern hospital are
impediments to achieving quality
care. The emphasis by physicians on
self-governance, self-monitoring, and
self-discipline creates a substantial
obstacle to an organization’s goal to
be a safe, effective, and efficient
system. This isolation of the medical
staff negates the reality that the
delivery of care is a multidisciplinary
process and must be approached as
such. Each board needs to ensure
that its bylaws specifically detail the
responsibilities it delegates to the
medical staff and the consequences of
not accomplishing these tasks. In
short, the governing body must take a
greater role in ensuring that quality
and safety goals are accomplished
and continuously improved by
remaining involved in all aspects of
clinical operations despite delegating
certain of these responsibilities
(Marren, Feazell, and Paddock 2003).
EMPHASIZE THE NEED FOR ADAPTIVE
CHANGE The relationship between the
board, executives, and medical staff