This was originally written last week for one of my grad school classes. I posted it here as I needed content to test with, but being that Gumbreaux is about anything and everything, I decided to leave it.
Legal battles between hospitals and their medical staff are a growing concern for healthcare organizations across the nation. From credentialing negligence, to bylaw modification, to improper privileging, courts are being forced to intervene in areas that should be managed judiciously within the organization. While in most instances there is a clear-cut definition of the issue, there is rarely a clear-cut solution. There are ways, through regulation and policy, to mitigate disputes, but ultimately, it may come down to a human effort to thwart future conflict. Creating and maintaining a healthy, open relationship between hospital administration, the board, and the medical staff is paramount in averting legal recourse and instead focusing on patient care.
In a case involving Avera Marshall Medical Center, hospital administrators modified bylaws without the required two-thirds affirmative vote of the medical staff. According to the hospital, this was necessary in order to continue operations, as key items such as credentialing were not taking place. A portion of the medical staff filed suit based on the hospital failing to follow its own bylaws; essentially breaching a contract between the medical staff and administration. The initial ruling was in favor of the hospital on grounds that the medical staff did not have legal standing to sue the administration. On appeal, the decision was overturned by the state’s supreme court who moved it back to district court for implementation. The lower court ruled that the hospital could unilaterally modify its bylaws without the vote by the medical staff. This decision was affirmed on appeal.
When an organization becomes internally unstable, in this instance, a bifurcated medical staff, the governing entity must have authority to make necessary adjustments for the betterment of the organization. It’s a fine balance between supreme governance and due compromise for all groups involved. Are there bylaw or policy changes that could have prevented this from going to trial? It’s possible, but not probable. There are healthcare organizations, such as Maramount Hospital, whose bylaws call for a simple majority vote of the medical staff to modify its bylaws instead of two-thirds. There are other organizations, such as UAMS Medical Center, whose medical staff executive committee consist of hospital administrators – albeit in an ex-officio role. Nonetheless, this allows for a better line of communication between the two groups. In the Avera Marshall case, it’s not clear if a majority vote versus 2/3rd would have alleviated the conflict, but it would have given higher odds of reaching a decision.
The true cause of conflict in the Avera case can be found long before any court battle. It’s clear that there was an internal divide and lack of leadership within the organization. Today’s healthcare entities are much more complex than they were just 10 or 15 years ago. Communication and collaboration are essential between the governing board, hospital administration and medical staff. The leadership from these 3 areas must form a strong professional bond that allows for transparency and trust to be built upon and maintained. Cross-placement of individuals is one way to achieve these results. Physicians on governing boards, medical directors on executive committee, physicians within the administration; these are all ways to create channels of communication so that conflicts can be resolved, or at least mitigated, before legal recourse is needed.
Jon Burroughs, in an article published in the Health Administration Press, said it best with, “[It is clear] that physicians, managers, and board members need to work together in new ways to optimize quality, reduce costs, and address conflicts and conflicts of interest in an open and transparent manner. Organizations are beginning to modify their operational structures to support a close and trusting working relationship by placing physicians on the governing board, the senior management team, operating boards, and other hospital-based teams.”8
As healthcare organizations continue to strive for providing the best in patient care, their internal administrative structure must be able to handle conflict, change, and growth in a manner that is conducive to productivity and prosperity. Management teams consisting of physicians and administrators that can work together with a synergistic and collaborative approach will ensure their organization has the foundation needed to survive in today’s healthcare world while minimizing exposure to internal legal action.
