Leadership

Enhancing Efficiency and Reducing Complexity: The Case for Medical Staff Unification

By Jennifer Mangan-Moore, CPMSM, MSM

As healthcare systems continue to expand and more physicians join the medical staffs of multiple hospitals, the need for streamlined governance, credentialing, and privileging processes has become increasingly important. Medical staff unification is an effective approach that can help create efficiencies, improve quality, and simplify administrative tasks across healthcare systems, as demonstrated by Aurora Healthcare (part of Advocate Health) where we successfully unified the medical staffs of 17 hospitals.

Benefits of Unification

A unified medical staff offers numerous benefits, not only for individual physicians but also for the organized medical staff and the operations of the healthcare system. One of the most significant advantages is the reduction of administrative burden on physicians. By eliminating redundant applications and committee reviews across multiple hospitals, physicians can submit a single application and complete the credentialing process once, saving valuable time and streamlining processes. Credentialing and recruitment teams benefit as well, with streamlined workflows that simplify the coordination of start dates and reduce administrative delays. Moreover, medical staff unification plays a crucial role in combating burnout, especially among physicians and credentialing staff. By reducing repetitive tasks and fostering a more collaborative work environment, unification can alleviate the strain of increasing workloads. Additionally, unified leadership provides a broader, more diverse perspective, leading to more effective decision-making in committees and more thoughtful development of policies, procedures, and criteria.

There are many potential benefits of a unified medical staff for the individual physician, the organized medical staff, and the operations of the hospitals and healthcare system. A unified medical staff significantly reduces the administrative burden on physicians by eliminating redundant applications and committee reviews for multiple hospitals. Physicians can submit a single application and complete credentialing once, saving time and ensuring a smoother process across hospitals. The challenge of navigating differently cadenced hospital committee meetings can be reduced or eliminated as applications can be approved by unified committees.

The system's credentialing and recruitment teams also benefit by streamlining workflows, making it easier to coordinate start dates across multiple hospitals. By streamlining administrative processes, unification reduces the repetitive and burdensome tasks that contribute to burnout, while promoting a more collaborative and supportive work environment. Additionally, the unified medical staff leaders have the opportunity for a larger view of the organization and more diverse input at their unified committee meetings, leading to more robust discussion and conclusions on policies, procedures, and criteria.

Medical staff unification requires a careful evaluation of the current structure and culture. For multiple medical staffs to unify, they must have a single governing body or delegate to a single body. It is very important to engage your legal team to assess if that legal structure currently exists in your organization, or if it is possible to create it, as there are many nuances to governance that must be considered. There also must be a desire by multiple hospital medical staffs to join together to unify. Understanding the current culture and environment of the individual medical staffs is key. Questions to consider are: Is there currently an appetite to explore unification? What is the current understanding of the medical staff leaders of the benefits of unification? What are the potential barriers to buy in?

Building Your Support Team

Once it is determined there is a desire to consider unification, having a support team established is critical. The support team should include legal, medical services, a senior-level chief medical officer (or equivalent), and a physician champion (ideally someone in high regard in a medical staff leadership position). The planning team, using the information they have gathered on the current state, should then develop a plan. Ideal steps within that plan include socializing the concept with local medical staff officers, then taking the concept to individual medical executive committees (MECs).

From those discussions, it’s ideal to collect and document what the MEC members are enthusiastic about and what they are apprehensive about. The planning team can then work through those apprehensions to build appropriate guardrails to the structure or bylaws. One key requirement is an opt-out clause in the bylaws, allowing a hospital’s medical staff to disengage from unification if desired.¹

At Aurora Healthcare, we identified additional apprehensions that included concern about loss of voice and loss of control of medical staff dues. To alleviate these concerns, we instituted an approach where each hospital has a voting representative on the unified credentials committee, unified MEC, and attendance at the governing board meeting. This allowed individual hospitals to maintain their voices while benefiting from a more streamlined governance structure. The issue of medical staff dues was resolved by keeping them at the site level, giving each hospital control over their dues and expenditures, thus preserving financial autonomy.

After all apprehensions are addressed, the final unified structure and bylaws can be brought forward to the site MECs for final input. For sites that wish to, town halls with active medical staff members can be held to allow for open dialogue and trust building. Then, the individual site medical staffs vote on the new unified bylaws, which creates the new unified medical staff.

Once the new unified bylaws are approved, the healthcare system must operationalize the unification. This includes adapting existing policies to a unified framework, creating new workflows for credentialing, unifying privilege criteria, and updating operational protocols. The transition also requires training staff to effectively use the new systems and forms, ensuring a smooth shift to the unified structure.

Key Learnings and Takeaways

Key learnings from Aurora Healthcare’s unification journey included:

• Consistently recognizing the unique cultures and needs of each medical staff and hospital to build a structure and approach that honors those.
• Focusing on creating a high-quality approach to credentialing, privileging, and governance that is beneficial for physicians and supports and elevates patient safety
• Assuring all medical staffs involved have a voice at the table.

When navigated thoughtfully and with attention to each hospital's unique needs, medical staff unification can transform the management of medical staff and healthcare system resources, streamline administrative processes, and enhance patient safety. By giving every hospital a voice and ensuring all stakeholders are engaged in the process, Aurora Healthcare’s unification journey serves as a model for healthcare systems looking to streamline their operations while maintaining a high level of care and oversight.

¹ Title 42 —Public Health Chapter IV —Centers for Medicare & Medicaid Services, Department of Health and Human Services Subchapter G —Standards and Certification Part 482 —Conditions of Participation for Hospitals Subpart C —Basic Hospital Functions, (b)(4)(ii)