Negotiating Medical Staff Privileges

Dr. Garrett, the chief medical officer of a busy tertiary medical center, was having a good day until Dr. Daer, a leading cardiologist at the hospital, approached him in the doctors’ lounge and insisted on speaking with him about an urgent quality problem. After retiring to Dr. Garrett’s office, Dr. Daer stated that a certain primary care physician (PCP) was, in his opinion, incompetent at reading EKGs (electrocardiograms). Dr. Daer claimed that this PCP’s incorrect reading of EKGs led to the recent death of a patient.

Dr. Daer said that he and all his partners were planning to propose that only cardiologists be credentialed to read EKGs or, as a concession, that all EKGs would be “over-read” or reread after a noncardiologist looked at them—and that the hospital would pay for these over-readings. This was a matter of such importance, Dr. Daer stressed, that he and his partners were ready to present the proposal to the medical executive committee, or even to take it to the hospital’s board of directors if necessary.

Dr. Garrett, now having a bad day, thanked Dr. Daer for the information, asked him to hold off on presenting his proposal to the medical executive committee or the board, and promised to follow up on his concern and get back to him within the next week.

Once alone, Dr. Garrett called the chair of the hospital’s quality improvement committee to see what quality issues had been reported from PCPs reading their own EKGs. The chair informed Dr. Garrett that this issue had been an ongoing battle between the cardiologists and PCPs. Five years earlier, new credentialing criteria were established for all physicians seeking EKG reading privileges. However, the cardiologists were surprised to discover that many of the PCPs met the criteria, and the cardiologists responded by voicing their concerns. Overall, the quality improvement committee had not found evidence that warranted taking this privilege away from PCPs. However, because of the friction the conflict had caused, the chair told Dr. Garrett, several PCPs had started to refer their patients who needed a cardiologist to other groups that practiced at other hospitals.

Clearly, Dr. Garrett had a serious problem to resolve. He thought about the situation and recognized that a distinction existed between the positions and the interests expressed. The positions—what people were demanding—were contrary. The cardiologists’ position of reading all EKGs was incompatible with the PCPs’ position of being allowed to read their own patients’ EKGs. The interests of both parties—their goals—were not incompatible, however. Both groups desired the continued long-term relationship among the medical staff and high-quality patient care.

To approach the issue effectively, Dr. Garrett realized that he needed to involve key stakeholders: the hospital’s executive administrative team, the medical staff president, and key cardiologists and PCPs. He made appointments to meet with each of them the following week.

Dr. Garrett’s challenge was to open lines of communication, reduce the ongoing conflict, and reach a win–win solution. For the negotiation, he had to determine how to align the seemingly contradictory interests of the two groups of medical staff to meet not only their needs but also the needs of the hospital overall, as well as maintain a high quality-of-care standard. To proceed, Dr. Garrett established the following key guidelines:

Ensure that communication takes place. Establish a way for real communication to begin between the two groups of physicians.

Build relationships. Bring the groups together to establish trust and long-term connections.

Get people off their positions. Explore the parties’ interests or goals to move them away from their expressed positions.

Facilitate effective negotiation. During meetings, ensure that professional language is used and appropriate engagement occurs. Keep the process moving, steer away from collisions and intimidation, and use the position of authority to ensure a safe environment.

Provide a reality check. Make certain the physicians understand the possible negative outcomes if a successful negotiation does not take place.

Bring workable new ideas. Come up with win–win ideas, but do not present them to both sides until the ideas are vetted by each side separately.

Consider an outside mediator. If failure remains a possibility, consider bringing in an outside mediator.

Now he just needed to move ahead with this task.

Case Studies:

The student will complete each case study scenario and answer questions from the case studies outlined in the assignment using the guide below. One reference (within the last four years). Address all five areas below.

1. Introduction

• Present an overview of the key problems and issues in the case.
• Provide a thesis statement that summarizes your analysis in one or two sentences.

2. Background, key facts, and issues

• Provide background information, relevant facts, and the most important issues.
• Tie to class materials, making sure to include how these issues impact the organization and individuals in the organization.

3. Alternatives

• Outline two possible alternatives.
• Discuss the critical constraints.
• Explain the strengths and weaknesses of the alternatives.

4. Proposed solution

• Recommend one solution.
• Explain why this solution was chosen.
• Support this solution with facts and class materials.
• Provide personal experiences, if applicable.

5. Recommendations

• Determine and discuss the specific strategies needed to accomplish the proposed solution.
• If applicable, define what further information is needed.