The Medical Director in Healthcare Institution: From Monitoring to Management for a Safer and Enhanced Quality of Clinical Care

Responsibilities and Monitoring Strategies

The medical field tends to become a turbulent environment due to extreme regulatory constraints and unmeasurable competitiveness. The Med must ensure an adequate environment of the working forces, notably the Physicians, given that the Med is theoretically liable of every process that may interfere directly or indirectly with the quality of care. Of note, the function of the Med is changing over time and it is evolving from what was a strictly “medical” function to a more extensive managerial function [3]. Professionalism in healthcare facilities is a minimal requirement and the Med is accountable for medical supervision and regulation of the overall medical facets that may affect the institutional healthcare system. The Med has to supervise and implement institutional policies, protocols and procedures, while coordinating with the Executive Director for better outcome. Issues related to professionalism, fairness, quality of care, patient safety and satisfaction, medical teaching and training, completion of medical records, continuous medical education, ethical issues and teamwork are the cornerstone parameters in the perspective of institutional development and improvement strategies [4].

In most healthcare facilities, physicians have frequently variable degrees of training and experience given their different background. One of the fundamental functions of the Med is to ensure that physicians have acquired appropriate certification, sufficient knowledge and skills before being enrolled as attending physicians in the institution. The monitoring strategies include the personal effort along with the sub-committees allocated in this perspective, and the main objective is to focus on patient safety, ensure advanced quality of care, avoid preventable medical errors, also the Med has to ensure that physicians engage in scientific events, comply with continuous medical education requirement. Table 1 shows the different parameters associated with physician professional record [5, 6].

CME, continuous medical education; CV, curriculum vitae [5, 6]. The Med (and the affiliated sub-committees) must be capable of gathering, processing all necessary data, including budget and reimbursement issues, to ensure best medical practice. In this regard, it is recommended to use objective qualitative and quantitative indices (metrics) to evaluate physician performance and clinical outcome.

Managerial and Organizational Tasks

The Med must develop cooperation with other directions (nursing and staff direction, financial direction, medical committee, etc.), also he/she has to ensure cooperation among the different medical departments, physicians, paramedics and other working personnel, for a better teamwork and enhanced clinical outcome, with an institutional culture based on the principle of “patient first”. The main issues to manage in this regard relate to patient safety and clinical outcome, quality of care, hospitalization rate and duration of stay, auditing and accreditation, standardization and research, ethical values.

Patient Safety and Clinical Outcome

The Med main role is to ensure patient safety and best appropriate clinical outcome, and he/she has to implement sufficient authority in this regard, and work on preventable medical errors, otherwise he may be transformed to a bystander Med. Performed by qualified appointees, regular audits on patient records and morbidity/mortality committees allow detecting and addressing any issue related to patient safety or any potential deficiency regarding quality of care. Medical record is the responsibility of the attending physician, the audit is based mainly –but not only – on the documentation found in the medical record [7].

Quality Assurance and Improvement

Quality assurance and quality improvement are optimally planned by a peer committee, and the Med is expected to approve and ensure implementation of quality improvement project within a timetable in order to evaluate results and to apply corrective measures. The Med has to monitor and manage the roadmap of any strategic planning, from idea to action, aiming to identify and address any potential factor of deficiency in any medical unit or division while targeting a patient-centered project [8].

Hospitalization Volume and Duration of Stay

Hospitalization rate and occupation percentage are essential parameters to estimate and adjust the flow of patients in the healthcare facility, also these factors are important for staffing and shift administration and scheduling. Moreover, hospitalization rate per physician is an important index to monitor, knowing that excessively low or high rate per operator may affect quality. Of note, some physicians may have a trend to unnecessarily prolong the hospital stay, and this fact is deleterious regarding beds availability, patients’ circulation and the institution image [1].

Internal Auditing and Accreditation

Auditing, whether internal (i.e. peer committee, auditing committee) or external (i.e. accreditation organizations), allows identifying potential deficiencies in medical units and divisions. Besides, auditing putting a framework as the basis of a quality improvement program, in order to enhance all components of the clinical care process, with a persistent focus on a patient-centered plan. Passive auditing is performed via the registry system, however, active internal auditing or accreditation committees allow to detect weakness and to set up a timetable plan for improvement in a form of strategic planning, under the supervision of the Med [9].

Relational and Ethical Issues

The Med may play a crucial role for teamwork enhancement, with a unifier profile based on equity, ethics, and professionalism. The Med has to control and restrict any potential abusive behavior of physician(s) in the healthcare facility. The Med has to apply sufficient authority when required to suppress ethical breach, otherwise, his function is simply relinquished and he may be transformed to a bystander M.Ed. Of note, many of the tasks of the Med could be deputized to the medical and units managers on a case by case decision. Figure 1 shows managerial and organizational factors on which the Med has to work on [1, 11, 12].

Click to enlarge

Challenges and Commitment

In an environment made turbulent by financial interests and aggressive competitiveness, the MeD must promote respect and ethical values based on fairness and integrity, promoting the spirit professionalism in the institution. The Med has the commitment to promote an institutional culture based on the principle of “patient first”. In this regard, an appropriate relationship between the Med and the attending physicians is essential and must be based on trust, respect and professionalism rather than excessive authority or unnecessary conviviality. In addition, the Med has to encourage multidisciplinary work – when necessary- for a better quality of care [13].

The Med must have an “evolutionary” or “revolutionary” mind to deal with every emergent situation, whether sanitary or financial or other (i.e. Covid-19, national political and/or economical instabilities, etc.), especially when the issue at stake is the institution sustainability (do-or-die). Accordingly, the Med has to predict and quickly define any threat in this regard, to measure the short and/or long term consequences, analyze the whole context, apply available tools for adjustment, also he/she has to hold brain-storming meetings to address any issue and avoid or limit potential damage. The Med must have a three-dimensional mind, thinking globally and applying locally in order to apply feasible management strategies even though some conditions (financial, technical, etc.) are not sufficiently or timely available in a respectable but less than perfect medical domain [13, 14].

The Med must have and/or develop the sense of communication, for negotiation with different stakeholders’ representatives (business, insurances and other third party payers, etc.). In addition, innovation and acquirement of new technologies and techniques must be well analyzed for its cost-effectiveness, while targeting quality of care and the prestigious image of an advanced healthcare facility. According, the Med has to be involved in the discussion of the institutional budget and financial capabilities [14].

The Med is supposed to update administrative regulations, also he/she must ensure obtainability of adequate and updated equipment, and allocation of high- quality paramedical assistance (nursing, secretaries, etc.), aiming to ensure professional standards in performance.

The Med is expected to develop and implement a strategic planning, with the participation of the different medical divisions and units, guided by a checklist and metrics of quality. Innovation in healthcare facility is a cornerstone for institutional sustainability and development, in order to keep updated with latest technology and techniques, also digital technology brings significant challenges that employees and physicians must keep up with it [1, 15].