Let's not break out the bubbly quite yet, but this week the Joint Commission (the organization formerly known as JCAHO) has slowed down the process of implementing a revised MS 1.20.  This standard would otherwise have become effective July 1, 2009.  In its current form, the proposed revision would require that (1) all substantive provisions of medical staff governing documents be included in the medical staff bylaws, (2) the bylaws — and all other governing documents (credentialing policies, manuals, etc.) be adopted by the entire medical staff membership (i.e., not just the Medical Executive Committee, or MEC) and (3) there be some mechanism for the full medical staff to overturn an action taken by the MEC. 

In theory, this makes the work of the MEC more transparent; in practice, this revised standard, if implemented, could provide for standoffs between different factions of a hospital's medical staff (e.g., MEC insiders vs. outsiders), and would require a very cumbersome process for amending any substantive policy.  

If an MEC wanted to, it could limit MEC circumvention of the full medical staff's wishes even without the MS 1.20 revision, e.g., by establishing MEC-recommended criteria for medical staff votes on these things.  For example, the MEC could propose a bylaw that says the MEC will bring a medical staff issue to the hospital governing board if 2/3 of medical staff asks it to (by vote or petition).

Given today's ever-shifting health care environment, the process requirements that would be imposed by revised MS 1.20 could hobble a health system working to position itself to better advantage within its market, eventually harming the interests of the medical staff membership they were apparently intended to protect. 

These revisions have been about five years in the making, and it's unfortunate that they still seem to be so far off the mark.

David Harlow