This transcript has been auto generated
00;00;03;25 - 00;00;27;03
Nick Healey
Hello and welcome to Beyond the Bylaws: The Medical Staff Show. This is Husch Blackwell LLP's podcast covering the legal and regulatory aspects of hospital medical staffs. We're focusing on the important but sometimes confusing world of medical staff legal issues. I'm Nick Healey, a health care regulatory partner at Husch Blackwell. And I am in my third decade of working with hospital medical staffs.
00;00;28;01 - 00;00;49;07
Nick Healey
Before we dive in, I'd like to note that nothing in this podcast constitutes legal advice, and the views expressed in this podcast are mine or those of our special guests and not those of Husch Blackwell. So I'm going to introduce our co-host for today, our special co-host, Amy Ligocki. Amy is a medical staff professional in Sheridan, Wyoming.
00;00;49;13 - 00;00;59;03
Nick Healey
And I've known Amy for about 15, 10, 15 years. But Amy, give us a little background. Tell us what you do and where you do it. And why you do it.
00;00;59;10 - 00;01;23;18
Amy Ligocki
Sure. Yeah. Thank you for having me today. And this is my first podcasting experience, but I'm happy to be here and I'm always willing to to talk with you about my passion of what I do in medical staff services. Yeah, I've been with Sheridan Memorial Hospital in Sheridan, Wyoming, for going on, this will be my 18th year. I was right out of college.
00;01;23;25 - 00;01;55;23
Amy Ligocki
My first job to Sheridan Memorial Hospital started in the quality department, and it kind of fell into the position of medical staff coordinator at that time and then built the program up to include both medical staff services and provider enrollment, credentialing and privileging and all those things that we'll probably talk about here. But you know, the why behind why I do what I do is, is really I've I've really found a passion for just serving the hospital in this way.
00;01;55;23 - 00;02;29;13
Amy Ligocki
I've been able to form a lot of relationships with physicians, nurse practitioners, physician assistants, to really be at the gateway to patient safety in a lot of ways in this work. And so it's just it's it's very evolving. It's always every day is different. And I have gotten my certification as a certified provider credentialing specialist, as well as a certified professional medical staff manager through the National Organization of Medical Staff Services, NAMS.
00;02;29;13 - 00;02;40;26
Amy Ligocki
So there's a lot of great work that a lot of people that in our world of health care do in this regard and so there's a lot of passion that goes behind it and very fulfilling work.
00;02;41;06 - 00;02;54;13
Nick Healey
You mentioned NAMS, the National Association of Medical Staff Services. We first, I think, became familiar with each other through whi ams the Wyoming Association of Medical Staff Services. Can you just talk a little bit about that?
00;02;54;26 - 00;03;21;03
Amy Ligocki
Yeah. So a subset of the national organization is affiliations in each state. And Wyoming, at the time that I came into the position, did not have its own state association. And so really it was all around networking with your cohorts around the state in in doing those similar work that we do within our own hospitals and, and not reinventing the wheel in a lot of ways.
00;03;21;03 - 00;03;51;05
Amy Ligocki
All have this work, very important work to do. And I felt like it was really beneficial that we all be a part of something together. Found that each state can be affiliated as an association and so brought a lot of people together. And it's it's been active for this whole time since 2012 and just really a great place for people to network and resource and get valuable information to help their their work.
00;03;51;14 - 00;04;01;22
Nick Healey
So medical staff professionals across the country, of course, they can join the National Association. And I understand that you've you've served in leadership positions with the National Association, is that right?
00;04;02;09 - 00;04;02;21
Amy Ligocki
Yes.
00;04;03;11 - 00;04;04;12
Nick Healey
And what are those?
00;04;04;16 - 00;04;35;16
Amy Ligocki
Yeah, I've been a director at large, which serves multiple states, so I've overseen other state associations, associations which is also part of the board of directors that oversees the whole national organization. There are about 6000 members currently on the National Association, so that's just shows all of those people in the background doing this work throughout our country. And and I've also served on exam writing task forces.
00;04;35;16 - 00;05;08;27
Amy Ligocki
So for the certification exams, I've helped helped write those exams and there's a lot of volunteer. Well, they're all volunteer actually, all of these positions I've worked on some tasks force for the profession in terms of advocating for our profession within our hospitals. Currently we are not classified as a profession. When, you know, in the h.r. World out there, but we are working towards that to be distinguished as medical staff professionals.
00;05;09;23 - 00;05;26;05
Amy Ligocki
So that's just a lot of really rewarding work that's being done at a national level. And there's a lot of opportunities or way more than we have time to talk about today, but it's just another passion to give back to those that are growing in this profession.
00;05;26;19 - 00;05;31;13
Nick Healey
And when you're not medical staff professional and you are a rancher. All right.
00;05;31;15 - 00;06;04;16
Amy Ligocki
I am probably far from being an actual rancher, but my husband is a rancher and I'm learning the ropes almost after 15 years of marriage. And so every day is a new day, but it's very it's all about the lifestyle. And we love it here in rural Wyoming. We can get away from all of, you know, all the all the things and really be proud of the land that we live on and growing our family and living off of, you know, the cattle that we raise and it's very rewarding.
00;06;05;03 - 00;06;08;25
Amy Ligocki
So, yes, it's great to be a Wyoming ite forever.
00;06;09;23 - 00;06;11;12
Nick Healey
So you're happy being a rancher.
00;06;11;22 - 00;06;13;00
Amy Ligocki
You sure? Yes.
00;06;14;02 - 00;06;16;24
Nick Healey
So would that make you a jolly rancher?
00;06;17;07 - 00;06;17;22
Amy Ligocki
Actually.
00;06;18;24 - 00;06;20;01
Nick Healey
If I had to do that.
00;06;20;13 - 00;06;22;07
Amy Ligocki
I would like to see I.
00;06;22;08 - 00;06;23;22
Nick Healey
Feel I feel compelled.
00;06;24;05 - 00;06;26;15
Amy Ligocki
I'll have to tell that to my husband tonight.
00;06;28;03 - 00;06;56;20
Nick Healey
I'm sure he's heard it before. Okay. Well, that's fantastic, Amy. I mean, I know your background. I know how qualified you are, how much experience you have in this area and how passionate you are about it. But I think it helps for everyone to hear that and for anyone listening that is just seeking an introduction to medical staff, professional work, further explanation of some of the topics that we talk about or we even touch on that go beyond the legal.
00;06;56;29 - 00;07;21;22
Nick Healey
I'm glad that you introduced NAMS, the National Association of Medical Staff Services and in our area, why? AMS And I understand that most states, if not all states, have chapters of NAMS, right? So there's Wyoming Association of Medical Staff Services. I've worked with the Idaho Association of Medical Staff Services. I haven't worked for them, but I'm sure there's Mams, the Montana Association of Medical Staff Services, CAMHS.
00;07;22;01 - 00;07;23;12
Nick Healey
I guess you just go on down the list.
00;07;23;20 - 00;07;29;12
Amy Ligocki
Absolutely. I believe all but a couple out there have their own associations. So.
00;07;29;27 - 00;07;38;08
Nick Healey
So I guess like Alabama, it would be AMS or they could call it Alabama. I think they should call in Alabama. So I hope they do.
00;07;38;08 - 00;07;39;08
Amy Ligocki
I like that one, too.
00;07;39;14 - 00;08;16;22
Nick Healey
I don't know if they do. Okay. So what drew you to medical staff, professional work in the first place? And I can tell you what I find most rewarding in medical staff, professional work is is really the impact on patient safety. I think it is an offer often overlooked first line of defense when it comes to patient safety, because you're doing the hard work of making sure that the providers who work in hospitals, ambulatory surgery centers, other facilities have the credentials and have the expertize, have the experience and skill to treat patients safely.
00;08;16;26 - 00;08;29;19
Nick Healey
And so I find that really compelling and it really makes me glad that I can play a small part in that, but you play a much bigger part. And so I'm wondering what draws you to it?
00;08;29;28 - 00;08;53;21
Amy Ligocki
Yeah, I mean, I would agree with all of those things. You know, I never thought that I would be doing the work that I do. And I think it's you know, you really feed off of why physicians are doing what they're doing in terms of they want to come and help you, help your family, provide safe and hopefully healing to those that need it.
00;08;53;21 - 00;09;20;02
Amy Ligocki
And for them to do that, there are a lot of things that go into that. You know, obviously they're going to school and getting training and and all those things. And we have to make sure that they're doing all of those things that they, you know, have gone to training and required to do their job and doing them the best ability that they know how and that they have all the resources to be able to do that.
00;09;20;02 - 00;09;42;17
Amy Ligocki
So yes, I believe we're at the forefront of patient safety and ensuring that, you know, your family, my family, everyone in your own communities are well taken care of and at the top. And so to have a piece of that, like you said, is is very rewarding and to build those relationships in that is also really rewarding.
00;09;42;23 - 00;10;19;09
Nick Healey
It's also pretty stressful. I know talking to medical staff professionals, it can be a very stressful occupation in calling, let's say, because I think medical professionals are doing a lot of the sleuthing, a lot of the investigation, and that is required in order to verify someone, you know, physician or other providers credentials and, you know, providers often they have a lot of you know, they have a lot of confidence, they have a lot of ego sometimes and having their credentials or their, you know, authority or skill or anything like that kind of quality improvement.
00;10;19;09 - 00;10;39;24
Nick Healey
Having that question, I think, can lead to a lot of drama, particularly when you get into the peer review areas which we are going to talk about probably mostly in later, later episodes. But the human drama inherent in medical staff issues always makes it interesting, if not pretty stressful sometimes. And have you noticed that?
00;10;40;01 - 00;11;10;16
Amy Ligocki
Yeah, I do see that. I feel that. And that's where I think growth happens a lot professionally for myself and for my colleagues. That's where that importance of forming those relationships and then also teaching and trying to get take those feelings out of that and really focus on the patient and the safety that goes around, why things are the way they are or why regulation is the way that it is.
00;11;10;16 - 00;11;39;01
Amy Ligocki
And sometimes we can't answer those questions right away, but it should all be focused around that patient safety piece. But yeah, there's there's I mean, I guess that's the intrigue of, you know, keeping moving always never a dull moment. Those types of things that really keeps you engaged and wanting to help and change and really improve processes so that everyone around you feels that this is the right thing to do.
00;11;39;06 - 00;12;04;16
Nick Healey
Excellent. Okay. So we're going to get into the meat of our episode today, which is really intended to introduce and give a high level explanation of a lot of the concepts that the medical staff professional who's first coming on the job where hasn't been in a very long are going to encounter and give them some context for a lot of the things that they're going to face in their their job.
00;12;04;16 - 00;12;29;25
Nick Healey
And so I think this is important to do at the outset because medical staff issues, and particularly when they intersect with the law, can be very complicated, a lot of complexity. And in my experience, there's been a ton of jargon and, you know, even on a lot of other hospital folks are unfamiliar with the concepts and what medical staff professionals do.
00;12;29;25 - 00;12;53;11
Nick Healey
So I think in throwing these these topics and concepts is going to be an important part of what we do in this podcast. So I guess let me, let me start off by asking you some very broad questions and I'll get your your take on those and then we can just chat about the answers. But the first is what is the medical stuff you tell me, what is the first thing that springs to mind when I say that?
00;12;53;11 - 00;12;55;02
Nick Healey
What is the medical staff, though?
00;12;55;02 - 00;13;25;24
Amy Ligocki
I think this is a clarity that we always talk about with with, you know, the lay of our board of trustees. But it's it's a self-governing organization. So, you know, they are governed by, you know, themselves in terms of composed of physicians or other health care providers that practice in the hospital and that governing body oversees and delegates, that responsibility for quality of care provided by those members.
00;13;25;24 - 00;13;36;05
Amy Ligocki
And so it's self-governing. And that's when we get into that. All those documents that are needed to assure that that self-governance is appropriately working.
00;13;36;08 - 00;14;09;18
Nick Healey
So to me, self-governing means that they're delegated a specific area of expertize or or competence and within that they have plenary authority. Let's just say that where they have pretty broad authority to do what needs to be done within that area and you mentioned being delegated the responsibility for quality of care in the hospital by, you know, the governing board, whether it's board of directors, board of trustees or any other governing board, could be board of managers if it's a limited liability company that runs the hospital.
00;14;09;25 - 00;14;19;08
Nick Healey
How have you seen issues with the medical staff having the resources to be able to carry out that self-governing responsibility when it comes to quality of care?
00;14;19;17 - 00;14;56;15
Amy Ligocki
Yeah, I think what we see a lot of is inconsistency is how to go about doing that. And so we're here to help support putting into place consistency through policies, procedures, bylaws to, you know, to align with all of the different regulations that go with that. So I do see that there there's a lot of confusion and and really it's hard to help them understand what self-governance means in terms of what their roles and responsibilities are.
00;14;56;15 - 00;15;00;08
Amy Ligocki
And so we are there to help guide in that regard.
00;15;00;25 - 00;15;26;26
Nick Healey
That's a really good point, because although we're kind of framing this discussion for medical staff, professionals and administrators and medical staff leadership, the average provider who's a member of the medical staff doesn't necessarily get a lot of orientation to the nature of the organization that they are a part of. And a very important part of and should be a very important part of their practice in a hospital.
00;15;27;07 - 00;15;38;08
Nick Healey
So do you see misconceptions or misunderstanding sometimes in what provider? Those who are part of the medical staff think that the medical staff is or should be and what it actually is?
00;15;38;14 - 00;16;05;25
Amy Ligocki
Yeah, absolutely. You know, all of this is, you know, a leadership position, I believe. Not all of it. But I think when they come in as a member of the medical staff, they're there to serve the patients. And they have a perspective of how they practice as a physician. And a lot of this administration of, you know, running an organized medical staff is outside of that practice of being a physician clinically.
00;16;06;08 - 00;16;25;23
Amy Ligocki
And so I think, you know, there's a lot of work that us as medical staff professionals can learn and help them understand how to be leaders and those structures to skirt structures of medical staff. And so I think there's just so much education that we can help them learn in that regard, in that way.
00;16;26;00 - 00;17;00;13
Nick Healey
And we talked about the medical staff's role being accountable to the governing body for the quality of care provided in the hospital. And there are various processes that medical staff professionals come under the medical staff professionals, job or purview, at least in part, that relate to that medical staff responsibility for quality of care. And I'm just going to name a couple here and and I'm going to ask for, you know, your your take on on how the medical staff goes through these processes, how they what their role in these processes are so credentialing and privileging.
00;17;00;13 - 00;17;21;11
Nick Healey
That's that's a huge one. And that is what I think if anyone knows anything about the medical staff, you know, in the medical staff professionals role, that is really what they think takes up the bulk of the MSPs time. And frankly, it probably does. And then you've got quality improvement. And I think quality improvement in hospitals can be separated out.
00;17;21;11 - 00;17;54;10
Nick Healey
There's often that administrative quality improvement or quality management department, they often interface with the medical staff, but they are often separate too. They don't always come under the medical staff. And then there's the peer review or corrective action processes by which, if something is noted, either through ongoing perspective or ongoing professional practice evaluation or focus, professional practice evaluation, OPI and FPP, which we're going to talk about in a subsequent episode.
00;17;54;10 - 00;18;10;26
Nick Healey
If something is noted through that, then the medical staff takes specific steps to remedy quality of care issues that are identified by that. And I think, Amy, you use this horrible acronyms, OPI and Sippy don't shoot for OPI and FPP.
00;18;11;15 - 00;18;29;13
Amy Ligocki
Yeah, I think when the Joint Commission came out with those requirements, you know, beside F PPE was just not fun enough to say so now we do for being OPI, you know, and, and you know, you hear in both ways FPP OPI sometimes it just rolls off your tongue a little easier, that being OPI Yeah.
00;18;29;14 - 00;18;59;07
Nick Healey
I don't know. As a, as a 51 year old, I just have a hard time saying Zippy or OPI. I don't know. Okay, so tell me credentialing and privileging. I mean that those are three words that are they just encompass a universe of activity for the medical staff professional. So tell me, you know, what is your view on or what would your explanation of credentialing and privileging be to someone who is totally unfamiliar with that?
00;18;59;16 - 00;19;34;10
Amy Ligocki
Sure. Yeah. I think credentialing and privileging are two different things. But one of each other in terms of they both have to occur within this process. And really it's the reviewing those credentials that those that provider has and you know, the training experience, the, you know, all the levels of education that they have gone through to become a physician, ensuring that they have completed all of those things without issue, you know, in the time periods of which they need to occur in terms of that education process.
00;19;34;10 - 00;19;59;04
Amy Ligocki
And so that that timeline of that and then the privileging piece is really what they are doing at the clinical site that you're at. And you know, each physician provider has their own specialty and where they've gotten their training and education. And so a surgeon would want to do specific surgical procedures. And so that's when privileging comes into play.
00;19;59;04 - 00;20;29;04
Amy Ligocki
And so you're looking at each of those specific privileges and having criteria to meet each of those privileges that they have to meet and maintain and to be able to do that specific procedure. And so, yeah, you know, we dove into this a lot more in terms of how how you do go about doing all of that. But really credentialing and privileging is is the main duty of, of the medical staff services to be able to ensure that our patients are safe.
00;20;29;04 - 00;20;31;12
Amy Ligocki
When a physician is providing that care.
00;20;31;21 - 00;21;04;13
Nick Healey
Would you characterize credentialing as the process of determining what a provider's qualifications to be a member of the medical staff are? And then privileging is a little more specific with respect to the specific clinical privileges that that individual want. So credentialing is a more broad process. It feeds into privileging because through the process of credentialing, you determine what clinical privileges someone is or appropriate for a particular provider.
00;21;04;13 - 00;21;05;12
Nick Healey
Is that a fair way to put it?
00;21;05;23 - 00;21;07;12
Amy Ligocki
Yes, absolutely.
00;21;07;12 - 00;21;29;09
Nick Healey
And then in the medical staff, you know, the medical staff doesn't make those decisions on its own, who gets to have what clinical privileges or whether specific credentials are sufficient for a person to be part of the medical staff that feeds up through a medical staff process. Right? Like so it goes from the MSSP, the medical staff professional.
00;21;29;09 - 00;21;54;12
Nick Healey
You get an application from a physician, the physician is filled out saying, I went to medical school here, I have these licenses. Here's my experience providing certain services that then goes through a committee process in the medical staff, usually credentials committee or sometimes department, department, chair, credentials committee, medical executive committee. And then where does it go from the medical executive committee?
00;21;55;09 - 00;22;21;06
Amy Ligocki
So the governing board is the ultimate decider of those set privileges membership and, you know, credentialing actions. And they oversee, you know, the quality of care within the health care organization. And so they delegate that medical staff to do those processes that then come to them for recommendation and granting of those specific privileges and membership to that individual.
00;22;21;14 - 00;22;49;02
Nick Healey
Okay. So they're working hand in glove, essentially at the medical staff and the and the board, the governing board are working hand-in-glove to make sure that only qualified providers are working in the hospital treating patients. So I guess that's where it comes back to the first line of patient safety, right? Like you are receiving the application, the physician or the provider, they basically, if you know, they can't show that they have the credentials that justify having the privileges they've asked for.
00;22;49;04 - 00;23;09;17
Nick Healey
You're the first line. You're the ones who tell the medical staff and then the board this information doesn't check out. So I guess that would be one way to describe how you the first line of patient safety. So then quality improvement. So tell me how tell me what you you understand is the medical staff's role in quality improvement.
00;23;10;06 - 00;23;45;05
Amy Ligocki
I believe it's really that, you know, maintaining and overseeing of all of that quality of care that those providers have been granted initially. So it's that maintenance of of looking at all of those ongoing evaluations across time and then, you know, making that recommendation, you know, on a reoccurring basis to assure that those qualifications are maintained. And, you know, really that quality of care is at the forefront and maintained for that provider over time.
00;23;45;05 - 00;24;05;00
Nick Healey
And really, the medical staff does that in large part through the committee structure, right? Yes. So what what I mean and anyone who's who's spent much time with medical staffs knows that there are lots and lots of committees trying to get providers to serve on committees, since maybe we should have a podcast episode on that. Not always.
00;24;05;10 - 00;24;09;28
Amy Ligocki
But at Centrex.
00;24;09;28 - 00;24;15;19
Nick Healey
So tell me a little about the committee structure. When it comes to quality improvement, what are the committees that are generally involved in that?
00;24;16;00 - 00;24;48;28
Amy Ligocki
Yeah, I think you've mentioned a couple already. Credentials Committee is a big one in terms of making sure those files are reviewed appropriately by medical staff members looking at any, you know, outlying flags in those applications and then, you know, recommending to those different departments and the ultimate medical executive committee, which usually encompasses all of the different chairs, chairman and chairwomen of each of those departments that oversee their own specialties within the hospital.
00;24;48;28 - 00;25;18;26
Amy Ligocki
And we also have other committees that are looking at the quality of care similarly to ensure that quality of care is being taken care of. With peer review, there is a, you know, infection prevention, pharmacy and therapeutics, there's critical care. I mean, there are different in every institution. But really the credentials committee, the peer review committee, the medical executive committee, those are the the ultimate recommending bodies when looking at the quality of care providers.
00;25;18;26 - 00;25;20;16
Amy Ligocki
Is that then filter up to the board.
00;25;20;21 - 00;25;48;08
Nick Healey
And peer review and corrective action? You mentioned peer review, the peer review committee. That is going to be a podcast topic in and of itself because that gets into what, you know, this kind of scary realm of fair hearings and, you know, disciplinary processes, corrective action processes. But that really is only one part of reviewing the care that's provided by the medical staff in the facility and improving the quality of care that's provided.
00;25;48;08 - 00;25;58;18
Nick Healey
So that is a big part. That is a part of it. And it tends to get a lot of attention. But it it isn't really the meat of what a medical staff does. It's only part of it. Would you agree with that?
00;25;59;08 - 00;25;59;22
Amy Ligocki
Yes.
00;26;00;03 - 00;26;14;19
Nick Healey
Okay. All right. So when we talk about the medical staff, we're talking I've said providers, you said physicians quite a bit. But who is it that we're talking about? What type of medical professionals are the ones that serve on the medical staff?
00;26;14;23 - 00;26;57;19
Amy Ligocki
Yeah. So we're generally talking about physicians and those could be MDs or Dios medical doctors or doctors of osteopathy, which both of those are signified by their training through different educational organizations to get those degrees. But we also include dentists, chiropractors, podiatry ists. So those are also referenced as physicians, doctors. And then we also have others such as clinical psychologists, nurse practitioners and physician assistants that fall within that provider category, typically that are granted those individual privileges to treat patients at the hospital.
00;26;57;19 - 00;27;18;23
Nick Healey
Sort of like physical therapists or speech therapists or dieticians. Yeah, licensed professional counselors do. They generally, in your experience, come under the medical staff or and the do they go through the credentialing processes of the medical staff or are they another type of entity altogether?
00;27;19;14 - 00;27;48;09
Amy Ligocki
Yeah. So I think it's it's based on organizational processes. They're providing a medical level of care is usually how we determine whether they're credentialed and if, you know, a lot of those answers, i mean, I think you work with, you know, the h.r. Processes if, if you're looking at certain accreditation, the joint commission, for example, you can process those types of people through an H.R. process.
00;27;48;09 - 00;28;16;25
Amy Ligocki
And it doesn't necessarily have to go through the medical staff, but that all has to be lined out in specific policy based on state laws. There may be some laws specific to their scope of practice that determine whether the medical staff should be granting them privileges or not. So, yeah, there's a lot of different licensed providers out there that need to be determined whether they provide specific clinical privileges through the medical staff or another arena.
00;28;16;25 - 00;28;34;16
Nick Healey
So everyone that puts hands on a patient in the hospital has to go through some kind of credentialing process. But not all providers, not all people who lay hands on a patient necessarily have to go through the medical staff process. Is that right? Practice? Yes. Okay. But they all have to go through some process.
00;28;34;29 - 00;28;41;26
Amy Ligocki
Yes. There their education, training and experience all need to be assessed before providing care to patients.
00;28;42;07 - 00;29;04;14
Nick Healey
And you made a distinction between providers that provide a medical level of care and ones that don't. And I know that you and I have had conversations about a medical level of care, and I know that that has been even a recent topic of conversation on the Wyoming Association of Medical Staff Services listserv. And so tell me how you make that distinction.
00;29;04;14 - 00;29;24;25
Nick Healey
What's your yardstick for when someone is providing a medical level of care? And that's a that's in the copy, right? That's the yes, that's Medicare's requirement in the conditions of participation for hospitals to make sure that anyone providing a medical level of care goes through the medical staff credentialing process is that right?
00;29;25;25 - 00;29;53;08
Amy Ligocki
Yeah. And I think that has a lot to do with the policies and procedures that you have in your bylaws, specifically to the medical staff as well as those discussions that are had with the medical staff in terms of if it's appropriate for them to be granting specific privileges based on their maybe their independence as a provider, their ordering ability to order specific medications or those types of things.
00;29;53;08 - 00;30;06;01
Amy Ligocki
If it's an independent decision or if it's something that they feel like the physicians need to have oversight on, that may determine whether they process through the medical staff versus, say, the h.r. Department. All right.
00;30;06;01 - 00;30;28;08
Nick Healey
We're going to skip ahead a little bit and talk about the medical staff organization itself. And I think you mentioned policy. I think you've mentioned bylaws. And so talk to me a little bit about the foundational documents of the medical staff, particularly with respect to bylaws, rules, policies. Why are there so many?
00;30;28;12 - 00;30;29;10
Amy Ligocki
And you.
00;30;30;00 - 00;30;30;19
Nick Healey
Explain.
00;30;31;01 - 00;31;08;01
Amy Ligocki
Right, these are the things that we we we read every night before we fall asleep. And, you know, to all those that document that I carry to every meeting and noted as my Bible and I mean, we all have to have these things. And I think it's all about being consistent across the board and understand adding that there are certain regulations out there that govern and, you know, laws, I think we end up being or trying to understand a lot of things that we never thought we would have to in terms of the law.
00;31;08;05 - 00;31;34;17
Amy Ligocki
And so it comes down to, you know, not the amount of paper that we have to read or have to put in place, but really that consistency of practice across the board and making sure we have a process for all the different things that we do. So yes, there are bylaws, rules and regs, policies and procedures. Those are probably the main documents that that we have in our medical staff services arena.
00;31;34;29 - 00;32;10;14
Nick Healey
And I like the way the Joint Commission distinguishes between bylaws and rules and regulations or policies in that the bylaws are supposed to contain the basic steps of processes, the basic principles that the medical staff is intended to govern itself by. And then associated details can live in rules and regulations and or policies. So you mentioned the bylaws is a document that you you read every night before you go to bed.
00;32;10;20 - 00;32;45;10
Nick Healey
I might want to recommend you join a book club that makes better recommendations than the man. If there was, like, a medical staff professional book club, I think it would be I think it would be really funny if they recommended bylaws to each other. But in any case, so having bylaws, having a foundational document that describes the organization of the medical staff and the basic steps of processes, the basic principles of that by which the the medical staff is going to govern itself.
00;32;45;23 - 00;33;05;08
Nick Healey
That's the foundational document. Right. You should go to that 1/1. If you have a question about how the medical staff is supposed to run, how it is supposed to do, what it's supposed to do, how it is supposed to police the quality of care, its relationship to the administration or the governing body. You really need to go to the bylaws.
00;33;05;16 - 00;33;06;23
Nick Healey
Is that fair statement?
00;33;07;20 - 00;33;28;04
Amy Ligocki
Yeah, I would agree with that. Okay. That goes into those as well as the ease to update and change specific to bylaws versus policies and procedures processes in that regard as well. So it's it's really a guidance tool, especially for those who are starting out in the field.
00;33;28;27 - 00;33;54;00
Nick Healey
So bylaws, you mentioned the ease of of changing them. So bylaws are intended to be more of a constitution. Is that a fair way to put it? Not easy to change. Pretty general can be expanded on in regulations which you could say take you know, stand in the place of laws or statutes and contain a lot of the details that you don't want to put in a constitution because it's pretty hard to change.
00;33;55;03 - 00;34;30;13
Nick Healey
You can change rules and regulations more easily. And then if there is a need to flesh those out even more specifically, you can have policies which describe in granular detail the associated parts of a a a rule and regulation. So one thing that a lot of medical staff professionals, especially ones who are just kind of starting out in larger facilities, may have a question about is how do the department or rules or departmental policies, how do those relate to the medical staff's bylaws or rules and policies?
00;34;30;13 - 00;34;54;11
Nick Healey
And I mean, to preempt a little bit, I, I would definitely recommend if someone is going through a bylaws drafting exercise that they, they spell that out in the bylaws that you know what the relationship between departmental rules or policies, medical staff, bylaws, rules and policies what that relationship should be. But from your perspective, how does that play out in practice?
00;34;54;29 - 00;35;05;00
Amy Ligocki
And you may have to clarify a little bit in terms of department mental policies, I guess. What are you referencing for a yeah.
00;35;05;08 - 00;35;28;09
Nick Healey
I'm happy to happy to clarify. So, yeah, one of the things that's that's going to be in the bylaws is the organization of the medical staff with respect to different types of providers and how they even further govern themselves. So you have a department of Surgery maybe, or a Department of Medicine and then, you know, potentially even under that, you have sections, right?
00;35;28;09 - 00;35;57;20
Nick Healey
You can have a section of pediatrics or obstetrics and maternal health, things like that. And so in a lot of cases, a department of the medical staff like the medical department or the surgical department will have their own policies that apply to those practitioners and govern very specific things that only relate to that type of practitioner. But you've got medical staff, bylaws, rules, regulations and policies as well.
00;35;57;20 - 00;36;00;04
Nick Healey
So if they conflict, who wins?
00;36;00;15 - 00;36;26;04
Amy Ligocki
Yeah, I think we all have to look at those different practices within each of those departments and have a process for those things in terms of making sure that they are then looked at by the whole medical executive committee that encompasses all of those different departments so that there isn't that conflict. Or if there is, then that's kind of hashed out at that level.
00;36;26;26 - 00;36;46;09
Amy Ligocki
So it just just like a credentialing file goes through each of those levels. There's a level of review for each of those department policies to ensure that everyone knows those things. But yeah, there's, there's probably conflict that occurs that really needs to go to that higher level of discussion.
00;36;47;06 - 00;37;01;29
Nick Healey
So they need to be consistent essentially. And if there's a conflict, you need some process to make sure that that that conflict can be resolved. And that's interesting. I mean, I've seen that in bylaws. I don't always see it in bylaws. But in your experience, is that pretty important?
00;37;02;02 - 00;37;03;07
Amy Ligocki
Yes, for sure.
00;37;03;14 - 00;37;10;04
Nick Healey
Any opportunity that we have to minimize conflict among different parts of the medical staff.
00;37;10;04 - 00;37;20;12
Amy Ligocki
I was just going to say it definitely makes for better relationships. I mean, that's what kind of keeps the things lively, but yet we want to keep everyone happy.
00;37;21;10 - 00;37;53;14
Nick Healey
Absolutely. Okay. So you as a medical staff professional, you deal with processes, you deal with information all the time. This podcast is really focused on the intersection of laws with medical staffs and their processes and the data they deal with. And we're going to be talking about particular legal topics in subsequent episodes. But from your perspective, what are the laws that come up that you have to deal with on a regular basis?
00;37;54;09 - 00;38;31;13
Amy Ligocki
We have to deal with there's a variety, but really when looking at the credentialing pieces, we are looking at our state laws, our peer review and quality laws in that regard, we're looking at the Health Care Quality Improvement Act, which is one that we'll probably dove into, but that oversees a lot of our peer review protections and then we've mentioned already today a lot about the Medicare conditions of participation, as well as state laws that are associated with that that really go through that accreditation, those standards.
00;38;31;13 - 00;38;56;08
Amy Ligocki
That is, if you're accredited, your institution is accredited, you want to make sure you're following as well. And so with credentialing, there's others that come into play. You know, those there's another acronym out there, the Impala. And you maybe we can dove into that another episode as well. But there's always the negligent credentialing laws that we all need to be aware of.
00;38;56;08 - 00;39;08;02
Amy Ligocki
You know, we hate to go down that route of being part of negligent lawsuits. And so to be prepared and to understand and know those types of laws is really important as well.
00;39;08;19 - 00;39;34;11
Nick Healey
And you mentioned the state law, peer review, quality improvement restrictions or statutes. And don't we talked about the data that a medical staff uses to perform its functions. In my work, a lot of the questions we get from medical staff to deal with confidentiality and privilege and under those states, peer review and quality improvement statutes, you know what is confidential, what is privileged?
00;39;34;11 - 00;39;54;24
Nick Healey
Why is it important to maintain those? And I guess I was if you could expand a little bit on that aspect of it and what you do to explain that to other physicians or physicians that are on the medical staff and why it's important for them to to maintain the confidentiality and privilege of the information they're dealing with.
00;39;55;06 - 00;40;19;25
Amy Ligocki
Yeah, I think goes back to the ability to talk freely a lot of the times within those different arenas. If we're talking about the care that a physician is has been given to a patient, they want to make sure that that information that they're sharing isn't going to be disclosed unless it has to be outside of that discussion.
00;40;20;05 - 00;40;56;13
Amy Ligocki
And so having state law, peer review protections that confidentiality is really to ensure that they can have those candid reviews of the members and that medical care. And then there can be those decisions made from their standard of care was met or not. And so that's always, you know, the discussion prior to having those meetings with members of physicians that are talking about a cases that, you know, things need to stay confidential and they are protected in those ways based on that peer review protection per state.
00;40;56;13 - 00;41;32;25
Nick Healey
And the protection relates to the confidentiality of the information. You mentioned the standard of care, which is a, you know, buzz or a buzz phrase in the medical malpractise world. And I think one of the critical things is, especially with respect to the medical staff's need to keep information confidential and privileged, is there's a tension there, right? Like there's a tension between their obligation, the medical staff's obligation to improve the quality of care, use the information that they get to improve processes, make sure that if the mistakes happen, that they don't happen again.
00;41;33;05 - 00;41;56;14
Nick Healey
And to disseminate that information so that can be used for that purpose, but at the same time not disseminate it in a way that is going to prejudice a medical staff member or their provider's ability to defend themselves if that mistake becomes the basis for a lawsuit. So I think that's that is one of the more interesting and important parts of what medical professionals do.
00;41;56;19 - 00;42;17;19
Nick Healey
And, you know, there's a lot of misinformation around around that. And so the more we can do to shed light on that, I think that is positive. And as you said, it improves people's ability to be candid in their review of their other members medical care. So I think that's a pretty critical part. Okay. So we are nearing the end.
00;42;17;19 - 00;42;18;10
Nick Healey
I can see.
00;42;18;28 - 00;42;20;15
Amy Ligocki
Robert the beginning. Right.
00;42;21;21 - 00;42;39;14
Nick Healey
Exactly. But yeah, nearing the end of the episode. And so I just want to take a couple of minutes and ask you, you know, you've been at this game for a long time now. Long time. You have a lot of years under your belt. Being a medical staff professional, what do you see as the biggest issues facing medical staffs?
00;42;39;16 - 00;42;43;15
Nick Healey
And I have my own list, but I'm curious about you coming.
00;42;43;15 - 00;43;22;04
Amy Ligocki
Issues are those that are I mean, I think it's all about forming that those relationships and really educating our positions on what medical staff structure and the importance of the job that we do. The issues always dealing with just those things that we've talked about today in terms of ensuring that we have consistency, that we have all the right processes in place to not have a negligent lawsuit, you know, the struggles of the tensions or the personalities that we have to deal with, I think those are always going to be there.
00;43;22;04 - 00;43;46;12
Amy Ligocki
But I think ultimately, if we can find a great way to educate and to have the patient at the center or at the forefront, I would say of our work is is really key to ensuring that those issues can be resolved. And so I guess I have a positive light on a lot of of things when when you approach a problem or an issue.
00;43;46;20 - 00;44;02;03
Amy Ligocki
And yeah, they're going to come up and we're going to have to deal with them based on what's on. But I think just ensuring that those relationships are there and that there's education out there that we can share to help support that is as important.
00;44;02;03 - 00;44;14;00
Nick Healey
So let me tell you my four and tell me if these resonate with you. So tensions between hospital employed physicians and independent physicians, is that something that you. Yeah, that's the thing. Okay.
00;44;14;06 - 00;44;18;21
Amy Ligocki
That's the thing that. Yeah. And there's been I think it's growing.
00;44;18;21 - 00;44;21;11
Nick Healey
I think it's I'm sorry I said it part again.
00;44;21;21 - 00;44;54;00
Amy Ligocki
Well and I apologize for interrupting. I, I think in in the world that I live in, that's it's really morphed a lot in the past, you know, 15, 20 years in terms of the structures of hospitals and the employment management of really taking in physicians as employees versus independent. But there are still independent physicians out there and comes competition and financial obligations of of both of those areas.
00;44;54;00 - 00;44;56;17
Amy Ligocki
And so there's definitely tensions that continue.
00;44;57;09 - 00;45;19;29
Nick Healey
And that does play out in the medical stuff. I have seen that in the past. I have seen those tensions come to the forefront in the medical staff discussions and whether, you know, someone is willing to trust someone else's judgment because they may or may not have the same economic interests at heart. It is an interesting one. And as new employment models develop, that may change.
00;45;19;29 - 00;45;42;27
Nick Healey
But for now, it's a thing, like you said, number two, lack of willing participants to fulfill the medical staff's obligations. So I briefly alluded to trying to find providers to fulfill committee roles and leadership positions in the medical staffs. Is that something that you've seen? I know that your hospital, you have a very committed medical staff. You have been very fortunate in that regard.
00;45;43;03 - 00;45;50;23
Nick Healey
But at other hospitals, it's tough. And so I'm wondering what you thought about that, what you think about that and what you guys have done to head that off?
00;45;51;11 - 00;46;14;14
Amy Ligocki
Yeah, it is definitely a challenge, even when you may think it's an easy thing for us right now. It's a continued challenge as we grow our medical staff, there's not a ton of people to choose from and so there's not a lot of rotating. But I think what key is out of that is really to identify the roles and responsibilities.
00;46;14;16 - 00;46;37;19
Amy Ligocki
You ask someone to be a chair of a department. They have no idea what that means and they typically will just not want to do it. Well, if you have a specific guidance tool and really set forth those expectations of the roles and responsibilities, it's very doable and with the support. And I think that is key to engaging all of that.
00;46;37;19 - 00;47;03;05
Amy Ligocki
And of course there's always the conversation around the time outside of their typical day that that takes and compensation packages in that regard, which can be different in any organization. And but I do think it's worth putting forth and having that conversation with leadership in regards to the importance of that role. And if that is needed to be maybe a paid or stipend position.
00;47;03;13 - 00;47;28;20
Nick Healey
So okay. The last two or kind of the last two are related, but power struggles between administration and medical staff over responsibility for quality of care and eroding of peer review protections. Let me just give you a little more flavor on the power struggle part. So as you said before, the the medical staff is delegated the responsibility for quality of care in the hospital.
00;47;29;02 - 00;47;52;06
Nick Healey
But the a by the governing board. But the governing board gives the administration they delegated to the administration the money right from the power over the resources that the hospital has is it's disposable. And so the medical staff, you know, it's kind of a bit of a rock and a hard place because it can't really fulfill its obligation without proper resources to do it.
00;47;52;08 - 00;47;58;11
Nick Healey
So, you know, have you seen that play out in hospitals that you've worked with?
00;47;58;24 - 00;48;28;07
Amy Ligocki
Yeah, I do see that it's different in every community based on those resources and the funding sources, as well as the structure and the leadership. You know, I see administrations that don't have those great relationships and connections with the medical staff, and medical staff needs to know the community needs as well and put aside maybe some of their individual needs.
00;48;28;12 - 00;48;44;22
Amy Ligocki
And so there's definitely conflict that can arise in that regard. And it should all boil down to what the best quality of care for the community is needed. And so they need to work together and figure out how to work together in terms of making best decisions.
00;48;45;14 - 00;49;27;16
Nick Healey
And you know, on the flip side of that, the administration needs data, right? They need information that the medical staff is ostensibly in charge of with respect to quality of care, you know, medical staff, credentialing things, medical staff credentialing information. You mentioned that I think provider enrollment comes into your department now. And so the state statutes that we discussed with respect to confidentiality and privilege of medical staff information, you know, that restricts how that information can be used or to whom it can be disseminated and the need for of administration for that kind of data to fulfill its responsibilities.
00;49;27;17 - 00;49;48;06
Nick Healey
Can we just mention and potentially eroding of peer review protections if information that was collected for either peer review or the medical staff purposes is used for administrative or other purposes for which it wouldn't be privileged? And so we only have a couple of minutes, but I'm just curious if you have a couple of words on how do you how do you manage that tension?
00;49;48;06 - 00;50;21;14
Amy Ligocki
Yeah, I believe, you know, medical staff serves professionals are kind of put in the middle a lot of times between administration, medical staff. And so it's not easy to understand both sides, but I think it is definitely worth understanding and having conversations around what the best way of going about that end to ensure that you have, you know, sharing agreements and those things put in place that those medical staff support professionals can really help have in place in order for that information, that data to be shared.
00;50;21;16 - 00;50;47;21
Nick Healey
Great. Well, that is all the time we have for today. We are in future episode. It's going to be expanding on some of the topics that we talked about today, including talking about the structure and best practices of medical staff, bylaws, peer review and corrective action. Sharing the intersection of hospital employment and medical staff. I know, Amy, for the Wyoming Association of Medical Staff Services.
00;50;47;21 - 00;51;12;01
Nick Healey
We've talked about the life cycle of the hospital employed physician. It's always a popular one. Nurse practitioners and physician assistants joining the medical staff are a very hot topic and call coverage issues you mentioned and Tyler and we will talk about the intersection of and Tyler call coverage and pay for coal you're nodding along I'm assuming that you've you've got some experience with at least some of those.
00;51;12;01 - 00;51;13;04
Nick Healey
Is that accurate?
00;51;13;04 - 00;51;37;13
Amy Ligocki
Yes. It's always a joy to hear more and to have those repeated. And so, yes, I appreciate all of the efforts that you will be providing to other medical staff professionals in this regards. Always a learning opportunity, regardless of how many years you have under your belt. And so thank you for having me today, Nick. And I look forward to more come in this regard.
00;51;37;24 - 00;51;50;26
Nick Healey
Yes. Thank you to Amy, the Jolly Rancher, Ligocki. We really appreciate you being on today. You're rolling your eyes. Come on. As your kids get older, the dad jokes are just going to be coming faster and thicker on the ground.
00;51;50;28 - 00;51;53;25
Amy Ligocki
I'm surprised that my husband had not had that yet.
00;51;54;04 - 00;52;02;21
Nick Healey
All right. Thank you, Amy. And I guess we will be we'll be back in touch. All right. Thanks for your time today.
00;52;02;24 - 00;52;03;09
Amy Ligocki
Thank you.
00;52;03;21 - 00;52;04;14
Nick Healey
Okay, bye.
00;52;04;21 - 00;52;05;02
Amy Ligocki
Bye.
00;52;05;26 - 00;52;48;12
Nick Healey
Thanks for listening. I'm Nick Healey. And this has been Beyond the Bylaws: The Medical Staff Show. We'll be back with a new episode soon. Stay tuned. Thank you.