Future of the Medical Staff Organization

Topics: Hospital-Physician Alignment, Physician Issues, Performance Improvement, Skill Development, Workforce, Organizational Models, Quality, Medical Directorships

While the medical staff organization was originally proposed by physicians as a venue for overseeing patient safety and clinical quality within the hospital, many medical staff and hospital leaders alike have come to question the effectiveness of the model given variety of alternative models for hospital-physician partnership and difficulty securing robust physician engagement. Nonetheless, the prospect of increasing accountability for the cost and quality of care delivered heightens the imperative for a high-performing medical staff organization. Drawn from interviews and surveys of innovative organizations, this study provides a playbook for refining medical staff structures and governance to support clinical quality.

After reading this study, members will be able to:

• Pursue principled medical staff organizational restructuring
• Enhance the effectiveness of medical staff leaders
• Bolster credentialing standards
• Refine approaches to physician performance improvement
• Revamp peer review processes

Executive Summary

Imperatives for elevating medical staff organization effectiveness
Emerging accountable care imperatives are prompting rapid evolution and innovation in hospital-physician partnership models. While the Clinical Advisory Board has studied a range of alignment strategies across the years, there is one enduring model that underlies all of these partnerships, the medical staff organization.

While critics claim the model is an anachronism, there are a number of countervailing forces that heighten the imperative for a high-performing medical staff organization today. First, there is the undisputable reality that the medical staff organization is a well-established regulatory requirement. Second, dysfunctional medical staff governance exposes both physicians and the hospital to legal risk. Third, new health care reform mandates are forcing all providers to reevaluate current partnership models in light of future accountability mandates.

Future success hinges on provider collaboration, strong quality foundation
The performance scrutiny providers will experience as these new health reform mandates and accountable payment methodologies emerge is further intensifying the imperative for aligned hospital-physician partnerships. As reimbursement systems evolve, hospitals and physicians will share an unprecedented amount of mutual accountability for the care they deliver, which will require a solid infrastructure for inflecting costs while delivering against more aggressive quality targets.

Reclaiming the relevance of the medical staff organization
Preparing for emerging financial incentives will undoubtedly require new investments and competencies, but it also reinforces the relevance of the medical staff organization given the key levers it provides for inflecting provider quality. While many hospitals are exploring new physician partnership models that advance quality goals, the medical staff organization provides a quality foundation that should be refined rather than re-created. Given the medical staff organization’s central role in establishing the criteria for new and ongoing membership, defining acceptable care standards, and, ultimately, monitoring providers’ ongoing performance, renewed investment in the organization is necessary for positioning both hospitals and physicians for long-term success.

Leading with quality-related medical staff reform
Of course, medical staff organization reform is complicated by the fact that hospital administrators cannot unilaterally make many any of these changes; most require a vote of the medical staff. Yet progressive organizations are making great strides by putting quality goals at the forefront of all medical staff reforms. Drawn from interviews and surveys of innovative organizations, this publication provides a playbook for refining medical staff structures and governance to support clinical quality. Overall, these investments in medical staff governance will be critical to driving the medical staff organization to a higher level of quality and laying a strong foundation for accountable care.

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