Eliminating committees makes many docs nervous
February 1, 1997
Eliminating committees makes many docs nervous
Yet fewer restructured committees get more done
Most physicians didn’t actively participate in The Methodist Hospital’s 28 single- specialty department meetings. But they balked at the idea of eliminating the departments in favor of multispecialty groups, says Valerie Purcell, RN, BSN, CPHQ, assistant manager of quality management.
The new committees, which include most specialties that would work on the same types of cases, are:
• cardiovascular surgery/cardiology/pulmonary medicine, which includes cardiovascular surgeons, cardiologists, pulmonologists, anesthesiologists, radiologists, and emergency department (ED) physicians;
• general/abdominal/pelvic surgery, which includes general surgeons, gynecologists, gastrointestinal surgeons, internists, anesthesiologists, radiologists, and pathologists;
• neuro/muscular/skeletal medicine and surgery neurologists, orthopedic surgeons, neurophysiology, neurosurgeons, anesthesiologists, ED physicians, and pathology;
• obstetrics/pediatrics/newborn care, which includes obstetricians, pediatricians, and related specialists;
• head/neck/integumentary surgery, which includes plastic surgeons, oral surgeons, ear and eye surgeons, and related specialists;
• medicine, which includes specialists in the areas of endocrinology, infectious diseases, nephrology, family practice, general medicine, hematology, oncology, and others;
• rehabilitation, which includes physical medicine specialists, but also neurologists, neurosurgeons, cardiologists and others because, as Purcell says, "these patients are still sick and need those kinds of physicians to take care of them";
• psychiatry, which includes internists and neurologists, for the same reason as above.
Be ready for initial resistance
"When we suggested this [change] the first response was, You’ve got to be kidding! A cardiovascular surgeon and a cardiologist can’t talk about cases. They don’t understand [one another].’ There was that stigma to get over. But [the new groups have] worked out very well," Purcell says.
Richard Harper, MD, chairman of the medical staff QM program, adds, "The biggest obstacle was that the average specialist would be livid if you insinuated that his results could be reviewed by someone who is not in the same speciality."
There were three keys in Methodist Hospital’s breaking through physicians’ skepticism about different specialties working together on the same committee, Harper continues. They were:
• to put in place experienced, strong, effective and respected committee chairmen;
• to have unyielding support from medical staff officers;
• to have strong support from hospital administration.
"Hospital administration support is more important than it seems at first glance," Harper adds. "We’ve had several instances where a prominent surgeon became upset that someone dared review his charts, and he went running to a member of administration saying, What are you going to do about this?’ Fortunately the administrator said nothing.’"
The new process has elicited more input because physicians aren’t as hesitant to "call their colleagues on the carpet for out-of-line practice patterns" when those colleagues aren’t in the same specialty. "It brings a true objectivity," Harper claims. "It works exceedingly well. It’s dawned on everyone that these committees make decent decisions and do understand the complexities involved."
Participation yields understanding
The Air Force hospitals met with the same kind of resistance when they disbanded physician committees, even though committee meetings were time-consuming and, physicians admitted, accomplished little.
The key element in getting past physicians’ resistance was getting them involved in the process, explains Sarah Tackett, ART, BS, CPHQ, chief of professional staff management at the Air Force Material Command at Wright-Patterson Air Force Base in Dayton, OH. "We actually got the chief of medical staff from each facility involved in developing the functional review process. Once they bought into the process, it was easy for them to go back and sell it. They played a pivotal role."
Tackett also advises that hospitals initially disband just one committee. "After the new process is implemented and working well with one function, it’s easier to implement for the rest of them," she says.
Hugh Greeley, chairman of The Greeley Co., a firm specializing in medical staff re-engineering, recommends hospitals survey physicians about which committees they feel substantially improve the quality of care to patients and which could be handled by an individual physician advisor supported by hospital staff. Greeley stresses physician education and keeping the lines of communication open. Administrators and physician leaders who advocate the change must be prepared to address physicians’ concerns. He recommends they read Reengineering the Corporation, by M. Hammer (Harper-Collins; 1994) and see a video called Discovering the Future: The Business of Paradigms, available through Chart House Learning Corp. in New Bernville, MN.
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