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The private practitioner in hospital quality assurance.

In many institutions, private practitioners are required to give rather freely of their time to perform quality assurance activities without financial remuneration. Without support, understanding, and performance of these tasks by practitioners, it would be impossible for the institution to meet the standards imposed by the external forces. Why should private practitioners agree to perform duties that have the potential of a negative personal effect? In most cases, they are required to do so as a requirement of medical staff membership. It is also possible that they perform these duties with the realization that, should they refuse to do so, the tasks would be performed by nonphysicians, in which case peer review would become "nonpeer" review.

As distasteful as it may be personally, physicians must continue to be actively involved in quality assurance activities, because the care a patient receives in an institution reflects a combination of efforts by both the institution and the practitioner. Rather than "finger pointing" episodes, when there is a flaw in the process or the desired outcome is not attained, both parties must, in an objective fashion, determine the cause of the problem and arrive at solutions that will prevent its reoccurrence. Case reviews must be conducted to determine institutional system failures as well as practitioner problems. When system failures are identified, corrective action plans on the part of the institution must be implemented, and the outcome of these plans must be made available to practitioners.

The practitioner must be educated on the importance of quality assurance activities as they relate to individual physicians and the institution. The practitioner must be kept informed of the requirements of external forces, with examples cited in which quality issues have the potential of negatively affecting the institution and the practitioner. The institution must perfect methods that will use as little of the practitioner's time as possible while attaining maximum effect from the energy expended. This can be accomplished by planning meeting times and agendas in advance, encouraging review of medical records before meetings, and presenting material to be reviewed in an organized fashion.

The practitioner must not only be appreciated, but also recognized and individually informed of the importance of the contribution he or she is making to the institution in these endeavors.

The "5/95" rule implies that 5 percent of medical staff members generally create 95 percent of the medical staffs problems in any institution. In a similar fashion, 5 percent of medical staff members usually perform 95 percent of the quality assurance activities. Although it is convenient to assume that the time and energy expended in quality assurance activities is equally shared by members of the medical staff, in reality this will never be the case. In the final analysis, while the institution and individual practitioners benefit from quality assurance activities, the work load is assumed by a few individuals who have seen the benefit of taking constructive steps to ensure that medical care of the highest quality is delivered in the institution.

Corporate America is raising its demands for proof that high-quality health care is being delivered to employees. It is reasonable to assume that a certain portion of future health care purchased for employees will be delivered by institutions that can supply such proof. Because both the institution and the practitioner will be affected by these demands, it behooves them to be actively involved in quality assurance activities to ensure that they will attract their fair share of the market. Quality assurance activities must become exercises that are performed with diligence and concern and not as drudgery simply because they are mandated. It is highly probable that institutions and medical staffs that fail to perform these activities in a satisfactory manner will regret their decisions, possibly too late.

Administration must believe that quality assurance activities are an essential part of organizational functions. Adequate financial and personnel support must be made available to ensure education of the medical staff in quality assurance matters and to carry out the program. The institution should recognize that there is a potential for either one or both of the following consequences for members of the medical staff who earnestly attempt to provide improvement in medical care via quality assurance activities:

* Practitioners in specialty areas are subject to losing referrals if they perform their duties in a manner that truly addresses quality issues.

* Practitioners who perform quality assurance activities may receive the "cold shoulder" from their colleagues and could suffer economic consequences.

Because quality assurance duties must be performed, as a measure of its gratitude, the institution should:

* Respect practitioners' time by supplying them with data and information before meetings; by presenting data in a format that is relatively easy to interpret; by encouraging medical record review before meetings, thus reducing the length of meetings; by ensuring availability of support staff to answer questions in a timely fashion; and by keeping the number of medical staff committee meetings to a minimum.

* Respect their opinions by implementing their ideas that have potential for improving the process and by giving reasonable explanations when their ideas are not implemented.

* Treat them with dignity by making them feel they are a part of the institution and by ensuring an active role for them in plotting the institution's future direction.

* Continually acknowledge their support of the institution by providing small tokens of appreciation, such as a fountain pen, a stethoscope, or a physician bag - items that are useful and that simultaneously express a simple "thank you."

J.A. Logan III, MD, is Medical Director, Community Methodist Hospital, Henderson, Ky.
COPYRIGHT 1993 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
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Author:Logan, J.A., III
Publication:Physician Executive
Date:Jul 1, 1993
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