Play by the Rules

The Hospitalist. 2007 December;2007(12):

December 1, 2007 | The Hospitalist

It is important for a group of any size to have a clearly designated leader to oversee its operations and meetings and represent the group to external constituents. It’s critical that all groups have a culture of physician ownership even if they are contractual employees of another entity, such as the hospital.

It is best if the leader is not viewed as a boss others work for. That will lead to an employee—not an owner—mentality on the part of the others. TH

Dr. Nelson has been a practicing hospitalist since 1988 and is co-founder and past president of SHM. He is a principal in Nelson/Flores Associates, a national hospitalist practice management consulting firm. He also on the faculty of SHM’s “Best Practices in Managing a Hospital Medicine Program.” This column represents his views and is not intended to reflect an official position of SHM.

AN EXAMPLE

By laws must be customized for each group; here’s one example of how such rules can look. They establish how the group can decide important issues for which consensus can’t be reached.

In the case of hospitalists employed by a larger entity such as a hospital or multispecialty group, these rules are not meant to suggest the hospitalist practice can make decisions independently. As employees of the hospital, the group must seek approval from the hospital and the practice medical director for all its policies and operations. However, there are many issues for which this approval can be anticipated, and the group will need a mechanism to establish how it will reach important decisions about them.

Regular Meetings

The whole hospitalist practice will meet monthly, or as required otherwise, to discuss and reach decisions on the group’s business; and
When possible, decisions will be reached by voice vote or consensus, but when these measures fail a vote (roll call or written) will be taken.

Who Can Vote

Any physician member of the group who works more than 0.6 of a full-time equivalent position and has been with the group for more than one year; and
All members are eligible to participate in discussions and make recommendations, but voting is limited to the above.

Majority Vote

A simple majority (more than 50%) represents a majority vote except as noted below; and
The medical director will have the authority to decide the outcome in cases of a tie vote that cannot be resolved with further discussion.

Quorum

Half of group members eligible to vote represents a quorum at any meeting.

Executive Committee

An executive committee made up of the practice medical director and three other voting member of the practice will meet monthly as required to address group issues and develop recommendations for consideration at the monthly meetings of the group as a whole;
The term of each executive committee member (other than the practice director) will be two years.