REVIEWED BY DAVID B. PRYOR, MD
BY CRAIG E. HOLM
Health Administration Press, Chicago, 2004, 114 pp., $59
(paperback)
The title, Allies or Adversaries: Revitalizing the Medical Staff
Organization, would suggest that this book is about the medical staff
organization. Indeed, the opening sentence — "Medical staff organizations,
which serve as the fundamental relationship between hospitals and physicians,
are an endangered species in the healthcare world" — would support that view.
The value of this book is considerably broader, however. I would prefer to view
the book as a primer on hospital-physician relationships. The book does address
key issues around the hospital medical staff that need to be addressed. Craig
Holm argues that the medical staff organization is the vehicle for revamping
hospital-physician relationships. Ultimately, the reader will have to decide
whether the medical staff organization is the key to creating successful
hospital- physician relationships. The value of the book, however, lies in its
dissection of the hospital-physician relationship.
The dissection occurs in seven chapters. Chapter 1 persuasively argues that
the relevance of the medical staff organization needs to be reconsidered in
light of trends and changes in the health care system. Chapter 2 outlines the
top 10 trends influencing medical staff organizations, as identified by the
futurist Russell Coile. Chapter 3 provides a short but excellent review of
medical staff planning needs, with helpful, illustrative examples. Chapter 4
provides a good framework for looking at incentives and drivers of physician
loyalty, with 16 specific strategies and examples of each. Chapter 5 outlines 13
competitive strategies and examples. Chapter 6 offers 15 techniques to foster
effective working relationships with physicians. The concluding Chapter 7
outlines an approach for how to get started.
The book is short (only 114 pages) and a seemingly quick read that is well
organized. I found myself thinking that much of the material seems so basic (the
exception is Chapter 3, on medical staff planning, which provides greater
detail), it raised the question: Who, running a hospital in today's complex
world, wouldn't think of the points being articulated? The answer to this
question underscores the value of the book. Although basic, the points
articulated by Holm are rarely considered in total. Consider one sentence from
one of the concluding paragraphs: "Medical staff organization of the future will
focus on the following six core areas: improving operations efficiency,
contributing to quality improvement, providing economic value for participants,
enabling flexibility and evolution, being inclusive not exclusive, monitoring
and evaluating performance."
I doubt there is any organization today satisfied with its current state in
each of these six areas. Going through the list and assessing the need in each
of the six areas will likely help the reader prioritize the work with his or her
own medical staff. It might also cause the reader to pause and ask him- or
herself whether there are other areas of importance (e.g. the role of the
medical staff and hospital in meeting community needs).
This book is not an exhaustive or complete reference guide. It will likely
raise more questions than it answers. At times, depending upon one's
perspective, the reader might identify significant omissions. The trends
identified in Chapter 2, for example, are important and relevant. They include
the predominance of independent physician practices, constrained reimbursement,
changes in ambulatory services delivery, elimination of certificate-of-need
restrictions, decline in physician professional fees, increases in physician
practice expenses, lingering effects of physician-hospital misadventures,
recruitment challenges, the nursing shortage, and service cooperation.
Not mentioned, however, are other trends that might be considered relevant,
such as the key role of physicians in hospital efficiencies and cost structure,
pay-for-performance initiatives, a payer model shifting to consumer-driven care
while consumer expectations change, quality of care becoming a central focus,
increasing technology capabilities, health care costs continuing to rise, the
lack of viable integrated models for care across the continuum that provide both
quality and the elimination of redundancy and waste, and the role of the
physician as team leader or team player for providing care.
The list of other possible trends above is not intended to detract from the
trends identified by the author, and it could be argued that many of them are
touched on or implied. As I read the book, I found myself repeatedly interacting
with the content. Are there other trends that are important? Are there other
core areas of focus? The reader looking for an exhaustive reference guide will
be disappointed. The reader looking for a starting point in considering his or
her medical staff organization will find the book a useful roadmap. The reader
looking for a Socratic checklist to help thinking and planning around
hospital-physician relationships will likely find great value in considering
strategic options and approaches outlined and well worth her or his time. Holm
has crafted an unusual book, one whose value is as much due to the interaction
with the reader as with what is written.
David B. Pryor, MD
Senior Vice President
Clinical
Excellence
Ascension Health
St. Louis
Copyright © 2006 by the Catholic Health
Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.