Working together to improve health care

Last week’s series of articles in the Bangor Daily News concerning the dispute between physicians and Eastern Maine Medical Center raises several troubling issues.

While the Maine Medical Association has no interest in getting involved in a local dispute, it is important for us as physician leaders to bring to the public’s attention system problems which may affect access to care or the quality of that care.

Maine’s health care delivery system is suffering from a number of stresses: low Medicare and Medicaid reimbursement, a tightening commercial health insurance market, and a growing malpractice crisis are just a few of the reasons. Those of us practicing in rural Maine know all too well all these stresses and challenges. But in many other towns and cities in Maine, physicians, nurses, administrators and hospital board members work together to address these problems. The complexity of providing quality care today requires this level of cooperation.

Having served as a medical staff president, I understand the dynamics of the staff-administration-board relationship. There are several ways to destroy these relationships, which are so critical to providing hospital care today:

. Reduce the number of medical staff meetings from once a month to only four times a year;

. Disempower the medical staff by placing most of the decision-making capacity in a small executive committee;

. Eliminate the Joint Conference Committee, which traditionally serves as a vehicle for communication between staff and board;

. Ensure that the hospital board is insulated from the medical staff by administration tightly controlling all communications to the board.

. Exclude physicians from the strategic planning and other decision-making processes critical to the future of the facility.

Unfortunately, this sequence of events happens at many hospitals in Maine and elsewhere. When a medical staff feels disenfranchised, and believes it has no voice in medical administration and in hospital decision-making, “going public” becomes a greater possibility. In fact, physicians have an ethical duty to be the “whistleblower” if they feel that care may be jeopardized.

While it is easy to know how to destroy the staff, the characteristics of a healthy medical staff-administration-board relationship are also relatively straightforward.

. Mutual respect and a recognition of mutual dependency;

. A more creative approach to hospital governance than the traditional model whereby a committee recommends, the board decides and the staff implements;

. Engagement of the medical staff in quality improvement activities on behalf of the hospital; and

. Regular processes which ensure good communication.

Administrators and trustees must realize that physicians are stakeholders in the affairs of their communities. They must, therefore, be included as active partners and collaborators in the future of health care and the decision-making process at all levels in their communities and in their state. If physicians are not an active part of this process at all levels, a clear recipe for failure has been developed.

I have every confidence that in Maine, physicians, hospital administrators and hospital trustees can work together to deliver quality health care. Our obligations to our patients demand nothing less.

Richard A. Evans, M.D. is a practicing surgeon in Machias and currently serves as president of the Maine Medical Association.