Empowering Family Physicians in Medical Staff Leadership to Foster Physician Well-Being

Empowering Clinician Voice in Health Care Governance

Physician executives, particularly the COS/MSP, serve as liaisons between operational leaders and the medical staff. Family physicians possess well-developed communication skills enabling them to foster relationships and to develop a deep understanding of the needs and concerns of the medical staff. We recommend the COS/MSP establish multiple feedback channels for medical staff to provide input, such as listening sessions and individual meetings with leaders and medical staff, to understand and address medical staff concerns. Providing multiple avenues to elicit medical staff feedback demonstrates respect and appreciation to the medical staff.

Effective communication channels, such as town halls and newsletters, keep medical staff informed of organizational priorities and facilitate alignment with patient care, quality, and sustainability. The COS/MSP should also regularly communicate appreciation and gratitude for the contributions of physicians to the organization. Although awards and recognition banquets are the most traditional form of such appreciation, other expressions recognizing the demands of clinical work and providing the resources and support for physicians to perform it effectively may be equally or more important. This includes attending to staffing, workflows, and the efficiency of the practice environment. Allocating dedicated space for breaks during the workday (eg, physician lounge, break rooms) is also important. Incorporation of free coffee, fruit, and healthy snacks are often greatly appreciated by clinicians on busy shifts with limited break time. Similarly, advocating for adequate space for lactation rooms in reasonable proximity to clinical care delivery areas should also be a priority to support physicians returning from parental leave.

Including the COS/MSP in the health system board and executive leadership team committee ensures the clinician voice is considered in the decision making processes. Regular meetings with senior leaders as well as a dedicated budget, and dedicated administrative support are vital components for the success of physician leaders in the COS/MSP key role. Considering the lengthy onboarding process typically required for a new COS/MSP to become fully acclimated, it is advisable to institute a minimum term of 3 years for the COS/MSP role. In addition, providing protected time, compensation, and access to resources such as executive coaching can further support COS/MSP effectiveness.

Physician-Centered Credentialing and Privileging

Oversight of the credentialing and privileging process is a core responsibility of the COS/MSP, guaranteeing that all health care professionals maintain competency and stay current in their fields. We suggest implementing several steps to transform the process into one that prioritizes the needs of clinicians. Streamlining annual training and replacing lengthy online modules with targeted briefs can improve efficiency and reduce burden. Training should be periodically refreshed and interactive to maintain physician engagement and interest. Credentialing questions about physical and mental health conditions can heighten or lessen stigma about help seeking, depending on how they are worded.⁶ These questions should be updated to treat physical and mental health issues similarly, avoiding outdated inquiries that violate American Disability Act regulations.⁷ Lastly, going through the peer review process (eg, being named in a malpractice suit or accused of unprofessional behavior) should consider very stressful events in the life of the physician. Emotional support should be provided to physicians going through this process. The frequency of malpractice suits and their negative associations with quality of life, career satisfaction, and overall well-being emphasize the need for organizations to not only provide legal guidance but also emotional support to mitigate the personal consequences of malpractice litigation for the physician.

Creating An Equitable Incident Reporting Processes

Setting and ensuring standards of professional behavior is a key function of the medical staff, with the COS/MSP playing a pivotal role in promoting interdisciplinary professionalism and addressing complaints. Traditional social contracts that tolerated unprofessional behavior are outdated. While systems to report such behavior have been established, they have evolved in unintended ways, eroding fair process and leading to issues of bias and discrimination. These systems often fail to consider multiple perspectives and can result in anonymous accusations being interpreted as “truth” without a complete understanding of the events. These systems can also lead to covert racial and gender bias and discrimination. For example, we have heard from women and minority physicians that they received professionalism complaints for giving assertive instructions to team members during a surgical procedure or critical situation that likely would never have been reported had such instructions been given in an identical manner by a male or a nonminority physician. Reports on professional conduct and patient safety, particularly the voluntary nature of these systems, may be influenced by the reporter's implicit biases.⁸ Structures need to be embedded within medical staff committees, patient safety, and professionalism reporting systems to mitigate biases regarding race, ethnicity, gender, and age. This involves mindful consideration of diversity and inclusion in committee memberships, implicit bias training, and regular collection and reporting of disaggregated data on medical staff diversity throughout the organizational hierarchy, extending inclusion efforts to nonphysician health professionals and patient representatives.

There is also a need for many reporting systems to be redesigned to better adhere to their intent and ensure fair process. The construct of fair process emphasizes that it is important to both 1) achieve the right outcome, as well as 2) attend to the process by which that outcome was achieved. Achieving fair process involves expectation clarity, engagement, and explanation.⁹ Redesigning professionalism reporting systems to ensure fair process, including replacing anonymous reporting with confidential reporting, is crucial.

Recognizing that physicians experiencing burnout may be more prone to unprofessional behavior^10⇓–12 also underscores the importance of addressing underlying factors and providing support as part of the professionalism reporting system. This does not excuse inappropriate behavior, but presents the opportunity to not only address it, but recognize underlying contributing factors which can be addressed it to help prevent future events. For example, when an individual without a history of professionalism complaints receives a new complaint, it is important to systematically assess whether a physician is in distress and, when appropriate, link them to resources such as peer support and confidential mental health and coaching. This approach facilitates the appropriate management of the event while concomitantly supporting a valued individual member of our medical staff.