Path to better relations between medical staffs and hospitals

It's no secret that relations between medical staffs and hospital governing boards have been strained in recent years.

Several lawsuits over the past decade have asked the courts to weigh in on things such as who has control over medical staff bylaws, privileging, contracting and quality issues. Often, both sides say the issues come down to patient safety and quality of care, and both sides say they need to take responsibility.

Having everyone in the hospital setting thinking about these areas is critical to ensuring patient safety and quality of care. It's time for the working relationship between physicians and hospital administrators to improve so that patients get the best care possible.

To ease strained physician-hospital relations, the American Medical Association House of Delegates late last year adopted 12 comprehensive principles to help build more effective relationships. The more than three-page "Principles for Strengthening the Physician-Hospital Relationship" grew out of the AMA Organized Medical Staff Sections' Governing Council.

In a nutshell, the principles say the organized medical staff should:

• Work with the hospital governing body to improve patient safety and health care quality.
• Be primarily responsible for credentialing and overseeing clinical quality and patient safety.
• Be involved in hospital strategic planning.
• Communicate with the hospital governing body in a timely and effective manner.
• Establish binding bylaws that hospital bylaws or policies don't undermine.
• Have inherent self-governance rights.
• Create bylaws that are a binding, mutually enforceable agreement between the medical staff and hospital governing body, and between the entities and individual medical staff members.
• Determine how much money it needs to carry out its duties and work with the hospital governing board to develop a budget that the hospital will fund.
• Elect member representation to attend, speak and vote at hospital governing board meetings.
• Have individual members be eligible for full membership on the hospital governing body.
• Develop disclosure and conflict-of-interest policies for physicians in leadership.
• Address disputes with the hospital governing body through a well-defined process.

These principles should signal to the health care community that there is an urgent need to find and build upon common ground between physicians and hospitals. And these principles should help expedite productive discussions between the AMA, the American Hospital Assn., the Joint Commission and the Centers for Medicare & Medicaid Services.

If physicians and hospitals follow the principles, that can go a long way toward preventing further erosion in the physician-hospital relationship.

And that will go a long way in ensuring patient safety and quality care.