Taking An Active Role In Medical Staff Leadership

By Larry Crystal, DPM

      “Good morning, Chief” “Here comes the Chief” and “Good morning, Mr. President” are all greetings that I have heard since I was elected into the position of Medical Staff President of a tri-campus rural hospital with 65 active staff and 45 mid-level providers. So how did the only podiatrist on staff come to serve as Chief of Staff?       Some might say that my election was the result of a fortune of circumstance and those with experience in medical staff leadership might say that I was the victim of circumstance. Regardless, I have had the honor and privilege of serving as the hospital’s Chief of Staff.       One of the first issues I faced in this position was whether the pediatricians should be in the operating room for scheduled c-sections. The anesthesiologists felt they should be present and the pediatricians felt that just being on call would be sufficient. After the respective camps made presentations to the hospital’s Medical Staff Executive Committee, the vote was tied. This is when I learned my first rule as the chair of this committee. In the event of a tie on controversial or divisive issues that come before this committee, the President casts the deciding vote.       The pulmonologist on staff approached me after the meeting and indicated that the podiatrist (yours truly) just set one of the c-section policies for the hospital. What was my response? I said it did not make a difference whether a podiatrist, a dermatologist or, for that matter, a pulmonologist makes the final call on the policy as long as the policy is well thought out and addresses the concerns of both sides of the issue.       Podiatrists can be successful in medical staff affairs and as more podiatrists serve as members of the active staff of their hospitals, involvement in medical staff leadership will be more common. One way to develop leadership skills is getting involved in various committees of the medical staff. I have yet to serve on a medical staff or hospital committee in which the hospital staff failed to value or appreciate medical staff involvement. Serving on the Credentials Committee, the Medical Quality Review Committee and/or the Performance Improvement Council can provide experience that should help provide a foundation for medical staff leadership. I have found that a foundation in these areas is most helpful as the President of the medical staff reports directly to the Board of Directors on the issues of credentialing and quality of care.       Following the process as outlined in the medical staff bylaws provides a road map for addressing tough issues. As the Chief of Staff, I have had to participate in and direct the investigations of fellow active staff members. This is not pleasant and knowing that you are following a process helps keep emotions in check that might otherwise get you in trouble.       It is important to keep in mind that medical staff leaders face issues that have many layers. Are physicians promoting a point of view for the best interest of the hospital or is there an underlying cause for their sudden concern? Are they trying to prevent the medical staff from taking a close look at their quality of care by raising an entirely different and potentially divisive issue? Are they fostering discontent among hospital staff because they are unhappy with an administrative decision that affects their practice? There are physicians on staff who are artists at manipulation and I am not talking about osteopathic manipulation.       As the Chief of Staff, I have promoted standards of behavior for the medical staff to reduce instances of disruptive physician behavior. During this time, we have promoted patient safety and this included involvement of the hospital in the Institute of Medicine’s 100,000 Lives Campaign. I led the rewriting of the physician proctoring, helped rewrite the medical staff bylaws regarding content of the medical record, and provided leadership in regard to the hospital’s conversion to electronic medical records. During my tenure in this position, I also regularly helped address physician concerns regarding transcription including educating physicians in this area. We also helped the hospital promote its service excellence campaign.       It has been a very worthwhile and educational experience. I encourage any of you with a keen interest in medical staff affairs to get involved.       Dr. Crystal practices in Maine.       Dr. McCord (pictured) is a Diplomate with the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.

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