As you know, we currently have both an elected President of the Medical Staff (me) and an appointed Chief of Staff (Larry Shuer).
Every two years the Medical Staff elects a Vice President who automatically assumes the presidency after two years. Historically, the office of President has been ceremonial and has had very little authority or function. Originally, the President usually was a community physician, although faculty members, including me, have been elected frequently in the past ten years. Interestingly and perhaps significantly, the Hospital Board of Directors does not acknowledge the existence of the President of the Medical Staff in its bylaws.
The Chief of Staff is now appointed jointly by the Dean of the Medical School and the CEO of the Hospital. The job encompasses many functions, including chairing the Medical Board and serving as an Associate Dean for Graduate Medical Education. The Chief of Staff also represents the Medical Staff to the governing body (the hospital board). Also, all Medical Staff quality, disciplinary, and credentialing functions are performed by the Chief of Staff and designates.
The California legislature passed Senate Bill 1325 in 2004. This law mandates that medical staffs be self governing and autonomous, not controlled by either a hospital or the governing body of a hospital. Medical staffs are required to have the ability to select and remove their leadership. Also, medical staffs must be represented by their selected leaders at governing body meetings. The Joint Commission and California’s Institute for Medical Quality (IMQ) based their citations on this law and certain JC standards that mandate a self-governing medical staff.
We were given 45 days to present a corrective process to the JC. To accomplish this, the Medical Board, at its June meeting, established a Governance Committee, chaired by me. [See list of members]. The charge of this committee is to present a plan to the Medical Board that would establish self-governance of the Medical Staff. One of our first actions has been to recommend that we change the name of the Medical Board itself to Medical Executive Committee (MEC) to be more consistent with other hospitals and regulatory agencies.
The JC’s action did not take us by surprise. The Medical Staff has been attempting to revise its governance structure for the past three years (since passage of SB 1325). The Bylaws Committee under the chairmanship of our President-elect, Bryan Bohman, has worked hard to present bylaws changes to fix governance issues as we saw them. However, it is now obvious that the proposed bylaws changes are internal and were not intended to solve the interorganizational issues that the JC is now mandating that we address.
How can we correct these problems? I will present several different possible interlocking scenarios that we have discussed as measures we might consider in the weeks ahead. There is an element of “mix and match” in each of these, but taken together perhaps they offer several pathways to solve the issue.
1. Elect a Chief of Staff and eliminate the position of President. This scenario would require a serious commitment by the elected Chief of Staff. It would also probably require a longer term of office than two years and greatly increased compensation compared with the President’s current honorarium. The job description obviously needs careful consideration.
2. Recommend that the Hospital establish a Vice President of Medical Affairs or Chief Medical Officer, fully funded by the hospital. This position (common in many other hospitals) would assist the elected chief of staff and perform many other hospital-related functions.
3. Ask the governing body (Hospital Board of Directors) to accept the elected Chief of Staff as the legitimate representative of the Medical Staff, allowing “attendance and voice” at its regular meetings.
4. Establish a transition period to accomplish these changes. During this time, a new election could be held for the new position of Chief of Staff. At this time, the current elected President could become the “past-President” with the right to attend Medical Board — or the renamed MEC — for two years (our current practice).
5. Consider halting the upcoming election for President-elect that is due to be held in August until we know what we are voting for.
Some colleagues have alleged that there is a “town-gown” conflict in the making. Our newly formed Governance Committee (consisting of both community and faculty representatives) at its first meeting made clear that this is not the case. In fact, this should be looked at as an opportunity to make the Medical Staff (consisting of both faculty and community physicians) stronger than it currently is.
The current composition of the Medical Staffs of Packard and Stanford is:
LPCH Total = 1001
Active = 825
Faculty = 652
Community = 349
SHC Total = 1851
Active = 1400
Faculty = 1142
Community = 710
We should all look forward to the proposals forthcoming from the Governance Committee to make our Medical Staff truly self-governing. These deliberations will fairly represent the interests of both the community and faculty. If you have thoughts on this matter, please contact me at kgarman@stanford.edu.
