Flashpoints in the Medical Staff World Horty, Springer & - PDF document

Flashpoints in the Medical Staff World Flashpoints in the Medical Staff World Horty, Springer & Mattern Philosophy that underlies all that follows: 1

Flashpoints in the Medical Staff World When physician leadership is as good as it can be, it gives every member the best chance to be successful. Leadership Drives Quality. Leadership Drives Behavior. 2

Flashpoints in the Medical Staff World Articulate High Standards. Shout Them from the Rooftops. Measure compliance; “publish” results. 3

Flashpoints in the Medical Staff World Intervene early. Make the problem part of the solution. 4

Flashpoints in the Medical Staff World Have good policies. Follow them. 5

Flashpoints in the Medical Staff World Making the Medical Staff Meaningful Does your medical staff delight? 6

Flashpoints in the Medical Staff World How do we get physicians to participate in the medical staff? ? Wrong question. Better question: What can the medical staff do to bring value to the life/practice of physicians – across the continuum? 7

Flashpoints in the Medical Staff World Collegial environment critical to joy in profession. Picture of joy is not a selfie. (Some speculate that a contributor to the high physician suicide rate is increasing isolation.) 8

Flashpoints in the Medical Staff World American Foundation for Suicide Prevention (2014) 300-400 physicians per year. Major Risk Factors • Depression • Bipolar • Alcohol/substance abuse No evidence that work-related stressors linked to elevated physician rates. 9

Flashpoints in the Medical Staff World • Medical students: 15-30% higher than general population • Male physicians: 70% higher than males in other professions • Female physicians: 250-400% higher than females in other professions Medical staff must create support for its membership in many arenas: Celebrate! Start each meeting with a joyful patient story. You have many. 10

Flashpoints in the Medical Staff World Remember why you do what you do. Why did you choose health care? • To please a parent? • Passion for science? • A doctor you admired? • Money? 11

Flashpoints in the Medical Staff World Health care chose you. Make meetings matter. 12

Flashpoints in the Medical Staff World Attending meetings should contribute to growth as a physician. Use case studies. 13

Flashpoints in the Medical Staff World Formal and Informal Meetings That Matter • Well planned • Substantive • Safe educational programs – starting with orientation: • The Board and what it does • Administration • Support staff • Preceptoring (buddy program) Formal and Informal Meetings That Matter • Expanded role of Wellness Committee • Consultation without stigma • Publicize its role • Facilitate consultations • Communicate in myriad ways • Require members to access available information • Informal, supportive, short get-togethers • Hotlines for news and concerns 14

Flashpoints in the Medical Staff World Formal and Informal Meetings That Matter • Food is love: meet in cafeteria or physician lounge each Tuesday at 6:00 a.m. or 11:00 a.m. for all who can make it • Congressional dining room and the demise of collegiality • Be the go-to source for information, assistance (like the Rapid Response Team that is available to help with EMR) What will work for you? 15

Flashpoints in the Medical Staff World Leadership Development • Recruiting, grooming your successors • Leaders “self-select” (with appropriate encouragement) • True leadership – visionary, quality- driven • Medical Staff [physician leadership] college 16

Flashpoints in the Medical Staff World • Someone told you: • “You’d be great at….” or • “Your skills would really move this project….” or • “You are so well-respected by your peers, you’d make a terrific.…” or • “Please help me out by reviewing these cases and.…” Introduce new leaders with small “wins.” 17

Flashpoints in the Medical Staff World Celebrate/reward good work Thanks. 18

Flashpoints in the Medical Staff World Eliminate Litigation • Define Standard of Care • Create Expectations • Education/Compliance/Enforcement • Assessment of high-risk practices − Quality − Risk − Training − Documentation − Practice processes − Environmental hazards 19

Flashpoints in the Medical Staff World But, bad things happen. • Investigate • Disclose • Apologize (Sorry laws) • Remediate What Is Cause of Litigation? • Bad outcome • Injury • Anger • Sense of unfairness • Vengeance • Patient/family wants to know what happened (cases withdrawn at conclusion of discovery) 20

Flashpoints in the Medical Staff World PHTS Experience A. Steps: 1. Prompt reporting of incidents 2. Prompt investigation, including interviews 3. Preserving records 4. Meet with injured party/family 5. Discuss facts openly 6. Offer remuneration commensurate with injury PHTS Experience B. Results: 1. Financial savings – 66% ($8 million from mid-2012 to mid-2014) 2. EVERY SINGLE INCIDENT avoided litigation 3. Average cost of early resolution case: $16,000 4. Average cost of one “progressing to lawsuit status”: $143,000 21

Flashpoints in the Medical Staff World Human benefits, too: • Sterile pack case • Picasso Creative ED Call Solutions 22

Flashpoints in the Medical Staff World DO NOT try to solve call problem one specialty at a time. Multidisciplinary task force designs solutions. 23

Flashpoints in the Medical Staff World Build fair call into all employment contracts. Create and market alternative multi-hour site for non-emergent care; permit immediate triage and transfer. 24

Flashpoints in the Medical Staff World ED directs all patients to hospitalists. Is this legal? ED contract (and bylaws) authorizes ED physician to admit to service of on-call physician. 25

Flashpoints in the Medical Staff World Deferred compensation. Old Is The New Useful 26

Flashpoints in the Medical Staff World “It is time.” Dignity in identifying and communicating with the aging practitioner. 27

Flashpoints in the Medical Staff World The Ultimate Balancing Act • Protect patients • Protect the practitioner • Protect other practitioners • Protect the organization • Comply with accreditation standards • Comply with Age Discrimination in Employment Act (ADEA) • Comply with Americans with Disabilities Act (ADA) Options • Provision in Credentials Policy/Bylaws for “Practitioners Over Age ______” • Late Career Practitioner Policy • Peer Review Policy • Practitioner Health Policy 28

Flashpoints in the Medical Staff World Practitioner Health Policy 29

Flashpoints in the Medical Staff World Medical Staffs should evaluate their unique culture and decide if an age-based rule makes sense in their hospital. Benefits of a Rule (e.g., a Bylaws Provision) • Protect patients • Reduce risk of negligent credentialing claims • Treat all physicians the same (thus reducing risk of discrimination claims) • Depersonalize issue 30

Flashpoints in the Medical Staff World Rule • One-year appointments • Age-based expiration • Required evaluation • Required CME • MOC Drawbacks of a Rule • Overly inclusive (affects physicians with no problems) • Controversial and inconvenient • Unnecessary if peer review process is working properly? • Difficulty interpreting test results (especially if no baseline) • Increased risk of discrimination claims 31

Flashpoints in the Medical Staff World Low Risk • Adopt and enforce evidence-based volume requirements for procedures for all physicians • Concurrent chart review of certain number of cases after age “x” • Annual reappointment • Concurrent proctoring of certain number of cases Some Risk • Require physician to have assistant at surgery or back-up immediately available • Comprehensive physical and psychological evaluations 32

Flashpoints in the Medical Staff World Do These Exams Yield Useful Information? • If no baseline to compare to, what do results mean? • Even if decline noted, at what level is it significant? • BUT – exams can be viewed as flagging mechanism for focused review of practice and outcomes High Risk Automatic loss of privileges after a certain age. 33

Flashpoints in the Medical Staff World Age Discrimination in Employment Act (ADEA) • Applies to “employees” (though some courts are interpreting broadly) over 40 • Prohibits employment action based on age • Applies to mandatory retirement, mandatory testing, etc. Can an aging policy treat all physicians the same (e.g., internists and surgeons)? 34

Flashpoints in the Medical Staff World Joint Commission Standard MS 11.01.01 Hospitals must have a process to address: − Education about impairment − Self-referral and referral from others − Confidentiality Joint Commission Standard MS 11.01.01 Hospitals must have a process to address: • Evaluation of credibility of complaint • Monitoring • Reporting when practitioner is providing unsafe treatment • Appropriate action 35

Flashpoints in the Medical Staff World Process • Education • Reporting • Fact-finding • Meeting • Evaluation • Resolution • Follow-up Education 36