QUESTION:
When a concern is raised about the behavior of a Medical Staff member, we’ve typically referred it to our department chairs to handle.  Some chairs do a really good job addressing these issues while others, well, let’s just say they struggle.  We were wondering if there’s a better way?

ANSWER FROM HORTYSPRINGER ATTORNEY LEEANNE MITCHELL:
Yes!  There are multiple drawbacks to asking a single individual – regardless of who that person is – to deal with difficult behavioral matters.

First, the department chair is often either a competitor or partner of the physician under review.  This can make it difficult for the department chair regardless of whether an actual “conflict of interest” exists.  Also, depending on the size of a department, the department chair may not deal with many behavioral concerns.  As a result, the chair never obtains enough experience to become truly comfortable addressing behavioral issues.  Finally, as your question might be hinting at, not all department chairs are created equal – some may have great leadership qualities, and some may be serving only because it’s a role that they are forced to rotate through in a particular department.

The bottom line when it comes to behavioral issues – especially ongoing patterns of conduct – is that it requires leadership expertise to address, not clinical expertise.  For that reason, we recommend appointing a small core group of experienced leaders – often referred to as a Leadership Council – to handle behavioral concerns.  The Leadership Council might be comprised of the Chief of Staff, Vice Chief of Staff, Chair of the Peer Review Committee, and the Chief Medical Officer.  Regardless of what it’s called, the advantages of using a Leadership Council approach to handle behavioral concerns include:

• consistency across departments (no more variability based on the personality and leadership skill set of individual department chairs);

• easier to avoid conflicts of interest;

• permits department chairs to preserve their working relationships with physicians under review;

• expertise through experience;

• emphasizes the importance of the issue and enhances the credibility of the physician leadership because a group of seasoned leaders – not a single person – is speaking with the physician under review; and

• problems are discussed by a small and nimble group, which promotes the exchange and development of ideas on a real-time basis.

If you have a quick question about this, e-mail LeeAnne at lmitchell@hortyspringer.com.