1. Medical Staff Meeting June 25, 2008

2. Purpose of the Medical Staff Organization Assuring Quality Care For All Patients

3. Assuring Quality Care through.. Effective Self Governance Advising the Hospital on matters affecting quality.

4. Issues Raised by Medical Staff Meetings are dominated by “dog and pony” shows; not physician driven. Many meetings are poorly attended / not effective. Effective Meetings = Specialty- or Issue-specific. Too long to move an issue through the current structure. High potential to lose track of an issue. Many opportunities for change involve more than one specialty to address. To continue Medical Staff influence in the hospital, we need a structure that is more effective in decision-making.

5. Rebuilding an Influential Medical Staff COMMUNICATION MEDICAL STAFF FUNCTION & FORM (i.e. Organization) LEADERSHIP DEVELOPMENT COMMUNICATION PEER REVIEW

6. Conceptual Design Board of Directors (Joint Commission Required) Bylaws/Credentials Committee QRC DIVISIONS of the MEDICAL STAFF Surgeons & Interventionalists Hospital Based MedicineCommunity Medicine Medical Executive Committee (Joint Commission Required SPECIALTIES OF THE MEDICAL STAFF AllergyEmerg MedGeneral SurgNephrologyOphthPediatricsRad Oncology AnesthEndocrinHospitalistsNeonatologyOral SurgPlastic SurgRadiology CardENTInfect DisNeurologyOrthoPodiatryRehab DentalFamily MedInternal MedNeuroSurgPain MedPsychiatryRheumatology DermGastroMed OncOB/GYNPathologyPulm/CritCrThoracic Surg

7. Conceptual Design DIVISIONS of the MEDICAL STAFF Surg & Intervent. Est. 76 Hospital Based Est. 48 Medicine Est. 61 Community Medicine Est. 56 SPECIALTIES of the MEDICAL STAFF Anesth Dentists OMSEmerg FamMed Allergy Gastro Card Derm Endocrin MedOnc Hospitalists IDIM Neph Neuro PMR Psych Pulm/CC Rad Onc Rheum Neo OB/GYN Path Peds GenSurg Ortho NeuroSurg Ophth ENT Plastic Pod Thoracic Urology Pain Med Radiology Ophth IM Card

8. Feedback Support for trying something new. Appreciation for flexibility and less formality. Requests to better understand how issues are managed and resolved in this proposed structure. Request for assurance that Voice by Specialty or by Individual could be lost. Why does Community Medicine division have as much representation on MEC as divisions with greater hospital involvement?

9. Changes Made Include Changes made to Division leadership roles. Changes made to MEC membership. Changed division assignments to “by President with member input”. Changed Division name to “Surgeons and Interventionalists” Stressed that any combination of Specialties can meet as desired. Stressed that one goal is elimination of formality – Meet wherever and whenever and report in. Clarified that the activity is focused on Specialties. Divisions meet as needed. Elected Division Leadership serve as facilitators and communicators. Clarified that Provider Support Services will continue to coordinate and document as needed.

10. Medical Executive Committee Voting members include: President, President-Elect, and Secretary-Treasurer Division Chief from all 4 Divisions Vice Chief from Hospital-Based, Surgeons & Interventionalists, and Medicine Divisions Total of 10

11. Medical Executive Committee Business includes: Performing the required regulatory duties of the medical staff; Acting on the recommendations coming up through the structure; Resolving issues only if they cannot be otherwise resolved. Ensuring effective and efficient decision-making leading to continued medical staff influence in the hospital.

12. Division Leadership: Division members elect Chief, Vice Chief, & Member at Large Chief, Vice Chief & Member at Large cannot be from same specialty within a Division Chief and Vice Chief serve on MEC (Chief only from Community Medicine) Member at Large responsible for overseeing peer review for Division and serves on QRC Vice Chief responsible for overseeing credentialing and serves on Bylaws/Credentials.

13. DIVISIONS: Coordination & Collaboration SPECIALTIES Hospital Based Surgs/Intervents Medicine Community Med Responsible for consulting specialties and members of each division for patient care initiatives, problem solving, etc. Collaboration As Needed. Attend meetings as interested. Drawn together by like types of care and how practitioners work together to provide that care. Shared interests, reflecting many existing cross- specialty activities. DIVISIONS of the MEDICAL STAFF

14. SPECIALTIES: Freedom & Flexibility SPECIALTIES Grassroots Structure Identifies and Drives Issues up through the Structure Flexible; Avoid Regulatory Requirements Physician-Driven Agendas Meet when/how/where/for what; no required content or minutes Meet in any combination with other Specialties as desired. Utilize any type of communication to conduct business PSS always available to coordinate, document, etc. Each Specialty elects a Representative

15. Specialty’s Voice More even balance between Divisions; More opportunity for all specialties to participate. Free to address own affairs w/o regulatory constraints. Multiple ways for members to participate (meetings, blogs, emails, faxes). Accountability to participate if want to have influence. Responsibility to Trust elected Leaders & support decisions.

16. Individual Voice Any medical staff member may: Contact any medical staff leader to voice a concern; Contact any medical staff officer to elevate a concern. Attend MEC to elevate a concern. Any medical staff member may attend at the invitation of their Division Chief attend MEC to voice a concern and vote on that matter. Participate regularly and timely in providing input into recommendations as they are considered via multiple channels (meetings, blogs, email, ballots) Vote on matters within Specialty, Division and Medical Staff as a Whole. Even after policy decisions are made, a petition process for reconsideration exists.

17. Form Follows Function How do we want to function? Empower Physician Driven Agendas Technology to give us options other than meetings, when appropriate Right People – Right Place – Right Time Remove regulatory-induced formality Work effectively despite % of medical staff disinterested or too busy Empowered core of leadership to ensure efficient decision- making and continued influence in the hospital

18. Two Way Communication Leadership is accountable to ensure information is in weekly or special newsletters and on electronic bulletin board. Future: Interactive Website Leadership is accountable to adequately notify constituents using technology or traditional methods regarding issues & opportunities. Members are accountable to receive information using these focused sources to stay informed. Members are accountable to provide input in a timely manner.

19. Patients count on the Medical Staff to counsel the Hospital effectively regarding things that impact Quality of Care. In order to promote the influence of the Medical Staff with the Board and Administration, the Medical Staff must function effectively.

20. Where do we go from here? Is this structure perfect? No Is it an individualized model similar to that working for other medical staffs? Yes Is it a well-thought out alternative with a high probability of success? Yes Will we modify it over time as we learn? Yes Please