At The Advanced Roundtable for Physician Leaders, we’ll help you work through the practical and legal considerations of the difficult situations medical staff leaders face. Through case studies and role plays based on actual situations, you’ll make tough decisions and deal with their consequences. These are examples of the case studies featured in these small, interactive sessions.
Performance Improvement and Peer Review Best Practices
The Peer Review Committee reviews a case that troubles many members but, due to the subjective nature of the review, the limitations of reviewing what is documented in the medical record, the deference to the judgment of the physician who was caring for the patient, and the nagging certainty that one of the reviewers’ own cases could turn up next, the case is assigned a “2,” meaning “I wouldn’t have done it this way, but not outside the standard of care.” Now, a real problem has occurred that will require an in-depth review or possibly limitation of the physician’s clinical privileges. A review of the physician’s file shows many “2s” that, in retrospect, seem indefensible. Is this the best way to improve quality and protect patients?
Behavior/Health Issues: A Difficult Mix!
Dr. Moody is a 55-year-old general surgeon who has built a large practice and has an excellent reputation in the community. Dr. Moody has been on the medical staff of St. Righteous Hospital for 15 years, and has served as a medical staff leader for the past seven years. Recently, Dr. Moody has had several verbal altercations with staff members and colleagues, written several letters severely criticizing other staff members, including the Chair of Surgery and the Chief of Staff, and made inappropriate, belittling comments to nurses. Dr. Moody is up for reappointment, and the Chair of Surgery is refusing to prepare a reappointment report for the Credentials Committee.
Are You Your Brother’s Keeper?
A family practitioner who admits very few patients to the hospital was arrested for DUI on Saturday night. What, if anything, do you do? Yesterday’s newspaper reports the largest malpractice verdict in the state was just awarded against an obstetrician on your staff. What, if anything, do you do? A patient arrives in the ED after suffering a perforation during a sigmoidoscopy done in a physician’s office. The physician does not have privileges to do sigmoidoscopies in the hospital. What, if anything, do you do?
A Beacon Through the Gray Zone
Is there a place on your medical staff for a borderline practitioner? If you are reminded that the Medical Staff exists to serve the patient and assure quality and safety, does that change your answer? If the marginal practitioner worries you, what do you do about it?
Setting the Bar
Dr. Gauss is the head of a moderate-sized cardiology group in Competition City. He and his partners have privileges for pacemaker placement for bradyarrhythmia. A pacemaker vendor proposed sending Dr. Gauss to Mexico City for a one-day training course in ICD implantation and then arranging for a board-certified EP physician to proctor him for five cases. Dr. Gauss and the
EP physician met with the Chair of the Credentials Committee to reassure him that with Dr. Gauss’s past experience with bradypacing, the proposed training would certainly be adequate. They then met with Administration to discuss an exclusive (discounted) contract with the vendor that was arranging for Dr. Gauss’s training to provide all pacemakers and ICDs for the hospital. What are the issues that this plan may raise for the Medical Staff and Administration?
Who’s Minding the Store?
Cardiology is the busiest, most profitable service at Heartland Memorial. But, the CEO is concerned that perhaps it is doing too well – that some of the procedures being performed may be unnecessary. The director of Cardiology reassures her that all is well – the cardiologists are highly qualified and, even though no real monitoring or review is done, his sense is that most of the care provided is probably quite good. Unsure, the CEO discusses the matter with the CMO and the Chief of Staff and wonders whether this is a matter that should be discussed with the Board.
The Hybrid Medical Staff — All the Rules Have Changed
While no one was watching, the voluntary Medical Staff disappeared. It has been replaced by physicians with contracts,hospitalists or other employed physicians, center of excellence in place of traditional departments, membership which votes by its absence instead of participation, physicians who scoff at the traditional responsibilities of the “voluntary” Medical Staff such as ER call, proctoring new colleagues, participating in committee functions and serving is leadership roles.
Is the “voluntary Medical Staff” now just a figment of the Joint Commission’s imagination? Are you keeping it on life support by paying stipends to physicians to perform what were once voluntary fuctions? Is there any advantage to physicians to recreate this organization? If so, what should it look like? Where should you start?
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