So now what? There’s certainly been a great deal of change in the Medical Staff organization and its interface with the Hospital over the past several months. We now have an elected Medical Staff leadership with representation on the SHC Board of Directors. We also have a newly-created full-time administrative liaison with the medical staff: the Vice President for Medical Affairs (VPMA). And we have a brand new Director of Medical Staff Services (DMSS) along with a new Medical Staff attorney.

All of these personnel and structural changes have occurred in the early stages of a whole new era for academic medical centers. The most salient feature of this paradigm shift is that relatively objective clinical quality ratings may now (fortunately) have more power in determining our future than subjective judgments based, somewhat tautologically, on prior academic and clinical reputation.

With new eyes looking at a medical staff organization, which itself has a new governance structure, there exists a unique opportunity, in the context of these new quality challenges, to effect meaningful change.

Mindful of this, a small group — consisting of Vice-Chief of Staff Geoff Rubin, VPMA Kevin Tabb, DMSS Debra Green and me — has begun meeting weekly to address strategic and tactical issues of concern to the Medical Staff and Hospital. We would ask for both your patience and your assistance as we identify and prioritize areas where the Medical Staff organization could better serve the entire institution, but here’s a preliminary report (strictly from my own perspective).

The primary concerns include:

Improving quality of care. This is of course the most important goal and the others listed below are properly viewed as subordinate to this ultimate aim. The MSO will be working closely with the quality department and clinical services to improve all aspects of care at SHC. An important role of the MSO is to help ensure that we don’t focus solely on those easily measured aspects of quality care which show up in public ratings and the like, but rather develop an institutional philosophy and approach to quality which permeates all of our care processes. Along these lines, we will be working to promote a “Just Culture” throughout SHC, meaning a philosophy of quality improvement which focuses primarily on processes rather than individual errors and which encourages the use of errors and “near-misses” as opportunities to improve processes rather than to “shame and blame” individual clinicians. (It sounds pretty straightforward, but it’s really contrary to a deep culture of individualism in medicine — more on this later.)

Improving the overall functionality of the Medical Staff organization: making the committees more efficient and productive, improving processes and service in the offices, and most importantly, ensuring that policies and procedures of the Medical Staff organization reflect the views of the rank and file Medical Staff members.

Improving physician engagement, “ownership,” and empowerment in the affairs of not only the Medical Staff organization itself, but through that mechanism to constructively influence clinically-relevant policies and decisions of the Hospital more globally. Of course that will require something other than a completely passive posture on our own part. One often hears the opinion expressed that this is an unusually “administration-run” or “nurse-run” hospital, with inadequate responsiveness to the concerns of the physicians. And it’s true that in the past, mechanisms for the medical staff to take responsibility and exert appropriate influence were somewhat undernourished. But our recent changes in governance represent an excellent opportunity to change all that, if only we make the necessary effort.

Improving the general sense of community among SHC Medical Staff members, along with improvements in collegiality, esprit de corps and general morale. Included in this is maintenance and improvement of the good relationship between community and fulltime faculty Medical Staff members.

These are admittedly very broad goals, and many are “motherhood and apple pie” issues, but I do believe it’s worth outlining them for your consideration — and your input. All of us who are working on these issues would be very happy to hear your points of view on any of them. Or if we’re missing something that’s of particular importance to you, please let us know.

It has been said that “politics is the art of looking for trouble, finding it whether it is there or not, misdiagnosing it, and then misapplying the wrong remedy.” (And that view was formulated even prior to our national experience of the past several years!) We need your help to avoid that fate. We are here to serve our Medical Staff, but we need to know what you want and need from us. As always, please feel free to contact me any time with your thoughts, comments, criticisms or tirades. I’m reachable at bbohman@stanfordmed.org. (But no, we cannot un-install Epic!)

Tribute to Larry Shuer:

For those who couldn’t attend, I can report that the reception for outgoing COS Larry Shuer was a truly lovely affair. Joe Hopkins MC’d, and tributes were offered by Dean Pizzo, Martha Marsh, Norm Rizk, Peter Gregory, Ann Dohn, and Geoff Rubin. I am chagrined that I missed my own presentation because of a surgical case which went much later than anticipated, but I’ll take this opportunity to say that after only a month in the job, I have a much deeper appreciation of the significance of Larry’s 12-year tenure as Chief of Staff — it’s a remarkable achievement indeed. The reception was a nice example of this institution giving appropriate recognition to extraordinary service. (Many thanks to Diana Adams, our Deputy Chief in Psychiatry, for spearheading the effort.) Of course we all wish Larry nothing but the best as he turns his attention to other challenges and opportunities.