3 9
A P R I L 2 0 1 5 | O U T P A T I E N T S U R G E R Y . N E T
chase of physician-owners' equity in the event they fail to meet well-
described standards of behavior. This termination of ownership rights
should be disconnected from the notion of medical staff peer review,
but your medical staff bylaws should also contain procedures to be
followed in order to suspend or terminate a disruptive physician's
privileges.
In accordance with Joint Commission standards, make certain that
these bylaws define acceptable, inappropriate and disruptive behav-
ior. The bylaws must describe the process and procedures for manag-
ing the latter two, addressing in particular the possibility of summary
suspension. A facility may find it necessary to invoke either or both
the repurchasing provision or the bylaw procedure as a remedy.
If the disruptive influence is an employee (since, let's face it, physi-
cians don't hold a monopoly on bad attitudes), contractual compli-
ance is likewise critical. Staff hired by way of written employment
agreements are subject to its descriptions of behavioral standards as
well as with- and without-cause termination provisions.
Those hired without formal employment agreements should have a
written policy explaining their behavioral expectations built into the
list of their job duties. Make it clear that a failure to act in accordance
with these obligations is grounds for immediate termination, and that
the policy does not change the status of their at-will employment.
Monitoring and correction
It's one thing to set up rules, but it can be quite another to enforce
them. This is often the result of money talking. To be specific: patient
referrals. "Look, George is a great hand surgeon, and he brings a ton
of cases to the facility. It's inexcusable that he flung another scalpel
during surgery, but if we kick him out, our distributions are going
to be peanuts."
