Managing Medical Staff Conflicts
Managing Medical Staff Conflicts By Elizabeth A. Snelson, JD.
Even if your medical staff has been operating smoothly, it needs to have conflict management processes in place to satisfy recently adopted Joint Commission standards. This is especially true if your medical staff does not operate smoothly, in which case conflict management should be built in to the medical staff bylaws, to keep quality medicine the top priority.
Conflicts with Hospital Board
Medical staffs and their hospitals’ governing bodies are supposed to collaborate, and have a mutual interest in providing care successfully to patients treated in the hospital. Occasionally, even rarely, the positions of the medical staff and hospital may diverge to the point of conflict. Conflict may arise from the board’s refusal to adopt medical staff bylaws amendments, or differences in opinion over the addition of a new clinical service. In such circumstances, conflict can undermine public confidence in the hospital, in potential patients or donors, and cause serious rifts in the collaboration necessary to provide care.
Effective conflict management processes avoid such consequences. To meet the requirements set out in Joint Commission Standard LD.02.04.01, Element of Performance 4, the processes should include:
Meeting with the involved parties as early as possible to identify the conflict.
Gathering information about the conflict.
Working with the parties to manage and, when possible, resolve the conflict.
Protecting the safety and quality of care.
Conflicts within the Medical Staff
When the medical staff organization confers considerable authority to the medical executive committee, or when the medical executive committee’s composition is not representative of the medical staff, or the committee otherwise fails to adequately represent members, conflicts can flare up between the two groups. Good organizational structure and effective leadership should prevent conflicts from happening, and are the best form of conflict management. A conflict management process is not just added insurance, but is necessary for compliance with Joint Commission Standard MS 01.01.01, Element of Performance 10, which states: “The organized medical staff has a process which is implemented to manage conflict between the medical staff and the medical executive committee on issues including, but not limited to, proposals to adopt a rule, regulation, policy, or an amendment thereto.”
The conflict resolution process is not required to address conflicts over medical staff bylaws amendments. Medical staff bylaws are subject to adoption by the entire voting staff, while rules, regulations, and policies can be adopted by the medical executive committee, if the medical staff has delegated it that authority. Conflicts between the medical staff and the medical executive committee over bylaws amendments are resolved by a long-standing conflict management system: voting.
Creating Processes for Conflict Management
The Joint Commission calls for medical staff conflict management processes to be in place, but does not provide much direction on establishing those processes. Here are some tips for setting up conflict management processes for your medical staff:
Put the conflict management process in the medical staff bylaws. Although not a requirement, placing them in the medical staff bylaws allows the medical staff organization and the board—two potentially conflicting parties—to vote on the processes, thus promoting buy-in, and giving the processes the weight of the bylaws.
The board does not decide. There is no reason why the medical staff should accept processes that direct all conflicts through information gathering and a meeting or two, only to be finally determined by the hospital board—but hospitals typically design them to do exactly that. Sadly, the Joint Commission does not call for the conflict management process to be fair. In the case of a conflict between the medical executive committee and the medical staff, it would be a contradiction of medical staff self-governance to involve the hospital board. In the case of a conflict between the board and the medical staff, the board would have no incentive to participate effectively in any discussion, much less compromise, if it ultimately can make the final decision anyway. That the board has “ultimate authority” does not mean the board cannot commit to an even-handed conflict resolution process.
Exempt Peer Review
While corrective action involving membership or clinical privileges may well result in conflict, peer review is no circumstance for a conflict resolutions process. The hearing and appeals procedures included in medical staff bylaws are (or should be) carefully designed to protect the members involved, and allow the member and executive committee to appeal a hearing committee’s decision, resolving peer review-related conflicts within the stipulations of Illinois statutes.
Medical staffs that have yet to adopt conflict resolution processes in their bylaws should be aware that the hospital may have adopted unilateral conflict management policies, without medical staff involvement. Do not wait for conflicts to arise before adopting conflict resolution processes.
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