Career and Life Planning Guidebook for Medical Residents

SECTION I: T MINUS THREE YEARS Tomorrow: Systems The need to work together has begun to cause the physical makeup of the hospital and medical staff to go through many changes and transitions. New physicians will find themselves in organizations in the midst of forming a new direction, with existing physicians seeking to protect their autonomy, and administrations seeking to engage physicians in care coordination. In 2016, The Joint Commission updated its 2009 leadership standards in its (Comprehensive Accred-itation Manual for Hospitals) that refocused the leadership structure of healthcare organizations from silos to a collaborative system: “For many years prior to 1994, the standards included chapters on ‘Management,’ ‘Governance,’ ‘Medical Staff,’ and ‘Nursing Services.’ Each department in the organization had its ‘own’ chapter of standards, as if the good performance of each unit would assure the success of the organization. The Joint Commission sought the advice of some of the nation’s leading healthcare management experts and clinical leaders from both practice and academia to redesign this unit-by-unit approach. They were unanimous in their advice: stop thinking of the healthcare organization as a conglomerate of units and think of it as a ‘system.’ A system is a combination of processes, people, and other resources that, working together, achieve an end.” 3 As a result of this shift in thinking about the structure of leadership for healthcare organizations, The Joint Commission created a recommended leadership structure that not only included the governing body of the organization (Board of Directors or Board of Trustees) and an administrative staff (C-Suite), but also a team of physician leaders (licensed independent practitioners) who could speak uniquely to the clinical aspects of care that drive quality of patient care and safety. According to the white paper, “In a hospital, this third leadership group is comprised of the leaders of the organized medical staff. Only if these three leadership groups work together, collaboratively, to exercise the organization’s leadership function, can the organization reliably achieve its goals.” With the need for collaboration among the three leadership groups of a healthcare organization, the functionandmakeupofthemedicalstaffischanging. Some health systems have combined/integrated their medical staffs to enable more standardization in clinical care protocols, reduce clinical variation (which usually affects quality and cost negatively) as well as to allow certain specialties to expand their care across the system to improve access to care and reduce cost and duplication. We believe this will only continue and increase. For now, hospitals continue to be required to have a medical staff (of some form or another) to meet Joint Commission standards. The question will be how to comply with these regulations while making the transition to clinical integration and accountable care, or how the regulations will be updated to adjust to new care models. CAREER AND LIFE PLANNING GUIDEBOOK FOR MEDICAL RESIDENTS 94