Restructure Medical Staff Phase II


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Restructure Medical Staff Phase II

  1. 1. Restructure Medical Staff Phase II
  2. 2. Medical Staff History <ul><li>1909 first Medical Staff was created to monitor quality in hospitals </li></ul><ul><li>NO SIGNIFICANT CHANGE IN THIS STRUCTURE IN 100 YEARS </li></ul><ul><li>Medicine now changing at rapid rate </li></ul><ul><li>Pay-for-performance is HERE </li></ul><ul><li>Current structure not agile </li></ul>
  3. 3. Prelude <ul><li>In 2000, at a Greeley Medical Staff Leadership Conference, we learned that most hospital have a two-year term for medical staff leaders </li></ul><ul><li>Looked at Medical Staff structures nation-wide and in our area </li></ul><ul><li>Rapid turnover of medical staff leaders and senior administration pointed to need for longer terms </li></ul><ul><li>We also researched with Health Care Advisory Board and had initial planning retreat in January with medical staff and Board. </li></ul><ul><li>We have had two subcommittee planning meetings in February and March of 2006 to develop OUR plan </li></ul><ul><li>We found the best structure was at Northwest Hospital and adopted it as our initial framework </li></ul>
  4. 4. Prelude Cont. <ul><li>2002 we implemented phase I of restructure </li></ul><ul><li>Started two-year terms for senior medical staff leadership, and created the Joint Operations Committee </li></ul><ul><li>We held off on phase II, due to financial concerns in early 2003 </li></ul><ul><li>We have had 6 months where we have had a retreat and planning subcommittee researching and revising our structure </li></ul>
  5. 5. Subcommittee Members <ul><li>Ed Eissmann Tom Smith </li></ul><ul><li>Eli Saikaly Kevin Clay </li></ul><ul><li>Jeff Winningham Pat Ryan </li></ul><ul><li>Art Grossman Ival Salyer </li></ul><ul><li>Larry Nicolov Jim Brevig </li></ul><ul><li>Todd Gunderson Larry Schecter </li></ul><ul><li>Janice Halladay Bob McKnight </li></ul><ul><li>Ruth Felthous Judy Good </li></ul><ul><li>Yvonne Strader Sridar Chalaka </li></ul>
  6. 6. A Possible Solution <ul><li>Unified Medical Staff Model </li></ul><ul><li>Goal is to combine and streamline the medical directors as well as the medical staff departments where appropriate and practical to meet the rapid changes in healthcare </li></ul>
  7. 7. Structure (Provisional) * MEC will review structure and adjust as needed * Specific specialties will elect their representative to work with section medical director. *Obligatory established contractual reporting requirements will be honored.
  9. 9. SPECIALTIES- DEFINED <ul><li>MEDICAL </li></ul><ul><li>Behavioral Health </li></ul><ul><li>FP </li></ul><ul><li>IM </li></ul><ul><li>Nephrology </li></ul><ul><li>Neurology </li></ul><ul><li>Rehab </li></ul><ul><li>Sleep Lab </li></ul><ul><li>Other as defined </li></ul><ul><li>SURGICAL </li></ul><ul><li>ENT </li></ul><ul><li>GI </li></ul><ul><li>GYN </li></ul><ul><li>Hand </li></ul><ul><li>Oto-Max </li></ul><ul><li>Plastics </li></ul><ul><li>Urology </li></ul>
  10. 10. SPECIALTIES- DEFINED <ul><li>Out Patient Non-Hospital based </li></ul><ul><li>Allergy/Immunology </li></ul><ul><li>Behavioral Health (OP) </li></ul><ul><li>Dermatology </li></ul><ul><li>Endocrinology </li></ul><ul><li>Rheumatology </li></ul><ul><li>Others as defined </li></ul>
  11. 11. Structure Cont. <ul><li>Ambulatory/Out Pt. Services Division </li></ul><ul><ul><li>300 MDs on Staff only practice in their offices </li></ul></ul><ul><ul><li>Create link to offices to assure that smooth transition of care from inpatient to outpatient. </li></ul></ul><ul><ul><li>There will continue to be specialty-specific recommendations for privileging by the Chairs/Directors of each section. (already doing this) </li></ul></ul>
  12. 12. Does this do away with the Medical Staff Leadership? <ul><li>Absolutely not ! </li></ul><ul><li>Medical Staff Leaders will still be delegated quality and credentialing by the Board of Directors </li></ul><ul><li>Medical Staff leadership will work closely with hospital administration and senior clinical leadership on operational issues </li></ul><ul><li>Medical Staff will actually have more input with the proposed new structure </li></ul>
  13. 13. Where Are We Now? <ul><li>Senior Medical Staff Leadership, two-year terms </li></ul><ul><li>“Super” Medical Directors </li></ul><ul><li>Created Joint Operations Committee </li></ul>
  14. 14. Proposed Changes for Phase II <ul><li>Division Chiefs </li></ul><ul><ul><li>Medicine </li></ul></ul><ul><ul><li>Surgery </li></ul></ul><ul><ul><li>Family Services </li></ul></ul><ul><ul><li>Ambulatory /Out Pt. MDs </li></ul></ul>
  15. 15. Division Chiefs <ul><ul><li>Two year terms, renewable (Conclusion of extension, 6 months prior to expiration of contract) </li></ul></ul><ul><ul><li>Nominated by Joint Operations (Board, Admin, Medical Staff) </li></ul></ul><ul><ul><li>Selection – may be nominated by division - and Interview Process </li></ul></ul><ul><ul><li>Final Candidate presented to Division </li></ul></ul><ul><ul><li>Approved by Division by simple majority </li></ul></ul><ul><ul><li>Initially ratified by MEC and Hospital Administration </li></ul></ul><ul><ul><li>Report to President of Medical Staff on medical staff concerns </li></ul></ul><ul><ul><li>Report to CMO for operational issues </li></ul></ul>
  16. 16. Selection of Division Chiefs <ul><li>Need to be an Active member of Medical Staff in good standing </li></ul><ul><li>Medical Staff and administrative experience preferred </li></ul><ul><li>Active 1/2 –time practice in community </li></ul><ul><li>If no internal candidate can be found and Medical Staff, Board, and Administration agree; then, an outside search would be started (e.g., Family Services) </li></ul>
  17. 17. Division Chiefs (continued) <ul><li>Responsibilities: </li></ul><ul><ul><li>Dyad model with Clinical Director for operations </li></ul></ul><ul><ul><li>Member of Credentials, MSQRC, Joint Operations and MEC </li></ul></ul><ul><ul><li>Responsible for QA, credentialing, and strategic planning in their division </li></ul></ul><ul><ul><li>Chair Quarterly QA for their division, and present issues to MSQRC </li></ul></ul><ul><ul><li>Implementation of policies for MEC </li></ul></ul><ul><ul><li>Have at least quarterly Division Meetings </li></ul></ul>
  18. 18. Chief Responsibilities (continued) <ul><li>Meetings with Section Directors at least quarterly or as needed </li></ul><ul><li>Time commitment 1/3 to 1/2 time </li></ul><ul><li>Compensation based on description and market equivalent </li></ul><ul><li>Annual ‘360 Review’ </li></ul>
  19. 19. Section Medical Directors <ul><li>Combines current medical directors with section chairs where appropriate </li></ul><ul><li>No additional medical directorships at section level </li></ul><ul><li>Responsible for QA, Credentialing, and planning in their section </li></ul><ul><li>Recommend clinical privilege criteria to Division Chief </li></ul><ul><li>Two-year term (may be renewed similarly to Division Chiefs) </li></ul><ul><li>Attend division QA Meetings, and other appropriate meeting as needed </li></ul><ul><li>Dyad Model with Clinical Director/Manager for operations </li></ul>
  20. 20. Section Medical Directors Cont. <ul><li>Nominated by MEC and/or section, and Hospital Administration </li></ul><ul><li>Selection and Interview process </li></ul><ul><li>Candidate presented to Section </li></ul><ul><li>Confirmed by simple majority of section vote </li></ul><ul><li>Ratified by MEC and Hospital Administration </li></ul><ul><li>Work closely with clinical administration on issues in their area </li></ul><ul><li>Compensation, hourly for medical staff issues plus medical director fees </li></ul><ul><li>Report to Division Chief </li></ul><ul><li>Annual evaluation by section </li></ul><ul><li>Not all sections will have their own medical director </li></ul>
  21. 21. Division Structure <ul><li>Medicine </li></ul><ul><ul><li>Hospitalists </li></ul></ul><ul><ul><li>Medical Specialties </li></ul></ul><ul><ul><li>ED </li></ul></ul><ul><ul><li>Radiology </li></ul></ul><ul><ul><li>Oncology Services </li></ul></ul><ul><li>Surgery </li></ul><ul><ul><li>General Surgery </li></ul></ul><ul><ul><li>Orthopedics </li></ul></ul><ul><ul><li>Surgical Sub-Specialties </li></ul></ul><ul><ul><li>Pathology </li></ul></ul><ul><ul><li>Anesthesiology </li></ul></ul>
  22. 22. Division Structure <ul><li>Family Services </li></ul><ul><ul><li>OB/Gyn </li></ul></ul><ul><ul><li>Peds (In-pt) </li></ul></ul><ul><ul><li>FP-OB </li></ul></ul><ul><ul><li>Midwives </li></ul></ul><ul><ul><li>Specialty Services from Children's </li></ul></ul><ul><li>Community </li></ul><ul><ul><li>Out-pt FPs </li></ul></ul><ul><ul><li>Out-pt IM </li></ul></ul><ul><ul><li>Out-pt Peds </li></ul></ul><ul><ul><li>Out-pt Specialty </li></ul></ul>
  23. 23. New MEC <ul><li>Membership </li></ul><ul><ul><li>Four, elected Senior Medical Staff - voting </li></ul></ul><ul><ul><li>Four Division Chiefs - voting </li></ul></ul><ul><ul><li>Hospital Senior Administration </li></ul></ul><ul><ul><li>Hospital Board Representation </li></ul></ul><ul><ul><li>Credentials Chair - voting </li></ul></ul><ul><ul><li>MSQRC Chair - voting </li></ul></ul>
  24. 24. How Do We Compare? <ul><li>Recently, several Medical Staff leaders, Board and Administration attended a governance seminar </li></ul><ul><li>Our proposed new structure was reviewed by Linda Haddad, a leading consultant on Medical Staff Issues </li></ul><ul><li>She was very complimentary of our structure </li></ul><ul><li>We are actually ahead of the curve </li></ul>
  25. 25. Election of Future* Division Chiefs <ul><li>Nominated by MEC, or division </li></ul><ul><li>Interview and selection process </li></ul><ul><li>Candidate presented to Division </li></ul><ul><li>Voted on by Division (see above) </li></ul><ul><li>Need to meet qualifications of Division Chief as outlined previously </li></ul>
  26. 26. Question? <ul><li>How do we elect Division Chiefs </li></ul><ul><ul><li>Nominated by Nominating committee or division, Approved by simple majority </li></ul></ul><ul><ul><li>Ratified by MEC and Hospital Administration </li></ul></ul><ul><ul><li>They will have two year contracts, with annual review </li></ul></ul><ul><ul><li>They will have dual reporting to President Medical Staff and CMO </li></ul></ul><ul><ul><li>They will work closely with clinical directors </li></ul></ul><ul><ul><li>Compensated by Hospital </li></ul></ul><ul><ul><li>Officers will be elected as usual as well as members of MSQRC and Credentials </li></ul></ul>
  27. 27. Potential Cost Off-sets <ul><li>Potential reduction in current medical director positions/hours </li></ul><ul><li>Potential reduction in hours paid for meeting attendance by medical staff </li></ul><ul><li>Stipend from Medical Staff for medical staff issues </li></ul>
  28. 28. Benefits for Hospital <ul><li>Aligns Medical Staff leadership to effectively meet challenges in our rapidly changing market </li></ul><ul><li>Establishes a leadership pool of MDs that will be responsible to implement operational issues with the medical staff </li></ul><ul><li>Has the potential to return much more on the investment, due to easier implementation of operational issues </li></ul><ul><li>Creates the framework for true partnership with the medical staff </li></ul>
  29. 29. Benefits for the Hospital <ul><li>Potential savings based on Chiefs becoming champions: </li></ul><ul><ul><li>Decreased Average Length Of Stay </li></ul></ul><ul><ul><li>Decreased resource utilization through standardization </li></ul></ul><ul><ul><li>Improved compliance with Core Measures and Pay-for-Performance measures </li></ul></ul><ul><ul><li>Improved Regulatory Readiness </li></ul></ul><ul><ul><li>Potential performance incentive programs </li></ul></ul>
  30. 30. Next Steps <ul><li>Change Bylaws (Bylaws Committee working on new changes) </li></ul><ul><li>Vote on by Medical Staff (early Fall) </li></ul><ul><li>If approved by Medical Staff, set up the interview process for Division Chiefs and Section Medical Directors </li></ul><ul><li>Target Implementation around January 2007 </li></ul>