QUESTION:
“Over the past several years, our system has created a number of service lines.  Each service line has a physician leader, along with an administrative and nursing leader.  Originally, the focus of the service line was on operational issues.  Now, the physician service line leaders want to be involved in credentialing, privileging, and peer review.  The problem is that our medical staff bylaws don’t mention service line leaders.  What should we do?”

ANSWER:
While most systems have developed service lines using a model similar to the one you described, in our experience, most medical staff bylaws are completely devoid of any reference to the service lines or service lines leaders.  However, it makes no sense for a system’s service lines and its medical staffs to operate in separate silos, especially when there are so many overlapping goals around quality of care and patient safety.  It’s time to act!

We recommend that you start by including references to service lines and service line leaders in your medical staff documents (e.g., bylaws, credentials policy, professional practice evaluation/peer review policy).  Ideally, these documents should reflect the expectation that service line leaders will participate in core medical staff functions, including credentialing, privileging, and peer review.

Your documents should also make it clear that when performing these functions, service line leaders will follow the process outlined in the medical staff bylaws and policies, and that service line leaders are also bound by the same peer review privilege and confidentiality principles.  It’s also important that the medical staff documents expressly allow for credentialing and peer review information to be shared with service line leaders (and vice versa).

The key is to make sure your medical staff documents are not an unnecessary impediment to needed change.  There are likely going to be some challenging discussions about how fully service line leaders should be integrated into core medical staff functions.  But if we keep our focus on doing what’s best for patient care, we will be able to move forward in coordinating service line leaders into medical staff processes and, hopefully, there will be added benefits of improving consistency and uniformity in decision-making throughout the system.