Hospital Prototype Board-Appointed Professional Staff By-law

1. Hospital Prototype Board-Appointed Professional Staff By-law Overview and Key Concepts February 2010 1

2. Overview Part I - Background/Context Part II - Overview of Key Components Part III - Implementation and Adoption 2

3. Part I - Background/Context

4. Background/Context Hospital governance practices have changed since the Prototype By-laws were last updated in 2003 Recommendations made by the Auditor General highlighted the value of skills-based hospital boards and the importance of recruiting board members with the required competencies toavoid conflicts of interest The jury in the Dupont/Daniel Inquest made recommendations aimed at strengthening the hospital-physician relationship and ensuring and promoting the safety of hospital staff and patients The 2003 Prototypes are simply not reflective of current practices, and as a result, recent adoption by hospitals has been minimal 4

5. Background/Context • In 2008, a joint OHA/OMA Task Force was established to provide overall direction and support to a targeted review of the 2003 OHA/OMA Prototype By-laws • The Task Force concluded its work in March 2009 because the OMA declined to continue discussions with the OHA on significant change • The OHA then proceeded on its own to develop new Prototype Hospital By-laws that we believe are well-suited to improving health system performance

6. Background/Context Features of the 2010 Prototype By-laws • Two distinct components: • Hospital Prototype Corporate By-law • Hospital Prototype Board-Appointed Professional Staff By-law • The Prototype By-laws are streamlined, shorted in length, and more focused on providing options for varying hospital needs • Hospital by-laws generally take this form given that corporate by-laws require less frequent updating and amendment • The Prototype Corporate By-law deals with a hospitals administrative functions • The Prototype Board-Appointed Professional Staff By-law deals with the appointment and privileging of medical, dental, midwifery staff and extended class nursing staff within the hospital

7. Background/Context The new Prototype Board-Appointed Professional Staff By-law is: • Reflective of the current operating environment for hospitals and meant to guide hospitals in amending and developing their organizational directives • Consistent with the jury recommendations in the 2007 Dupont/Daniel Inquest • Compliant with the Corporations Act, Public Hospitals Act and other relevant legislation • Less prescriptive and more flexible than previous versions and available in digital format, so can be fully customized by hospitals 7

8. Background/Context Development of the Prototype Board-Appointed Professional Staff By-law • Guided by a Working Group • Composed of hospital CEOs, Chiefs of Staff, Vice President Medicals, Chief Nursing Executives, and in-house legal counsel. • Assistance of hospital in-house and external legal counsel was sought in identifying areas of interest and/or issues to inform by-law development

9. Part II – Overview of Key Components

10. Overview of Key Components Professional Staff (Designation and Categories) • Medical Staff, Dental Staff, Midwifery Staff and Extended Class Nursing Staff (non-employed) are defined as "Professional Staff" and are generally treated in the same manner • Prototype Board-Appointed Professional Staff By-law provides for one process for applications/appointment, categories of staff, revocations/suspensions and duties, but distinguishes between the various certificates and licences that might need to be provided • The Prototype By-law removes Temporary Staff as a category and sets out provisions in the sections on appointment and reappointment

11. Overview of Key Components Appointment and Privileging • The Prototype Board-Appointed Professional Staff By-law broadens the qualifications and criteria that must be satisfied in order for a member of the “Professional Staff” to be eligible for appointment or reappointment, including: • Evidence of up-to-date inoculations, screenings and tests as may be required; • A demonstration of adequate control of any significant physical or behavioural impairment affecting skill, attitude or judgment that might impact negatively on patient care or the operation of the corporation; • An Impact Analysis demonstrating that the Hospital has the resources to accommodate the applicant; and • Provisions that would permit the board to refuse to appoint an applicant on certain grounds.

12. Overview of Key Components Appointment and Privileging (continued) • Notes/Appendices included which relate to appointment and privileging: • Application for Appointment (Appendix I) • Annual Review for Reappointment (Appendix II) • Duties of Members of the Professional Staff (Appendix III)

13. Overview of Key Components Monitoring, Suspension and Revocations • The Prototype Board-Appointed Professional Staff By-law provides a streamlined approach in which the suspension, restriction and revocation of privileges applies in all situations, regardless of whether or not the action is urgent or not • Extends the authority to temporarily restrict or suspend privileges to include the CEO (in addition to the Chair of the Medical Advisory Committee and Chief of Department) • The circumstances in which temporary suspension can occur are expanded beyond “exposing patients to harm or injury” to include situations where the members conduct, performance or behaviour exposes (or is reasonably likely to expose) any patient, health care provider, employee or other person at the hospital to harm or injury

14. Overview of Key Components Leadership Positions • Hospitals currently operate under a number of different leadership models dependent on various factors including hospital size, geographic area, and community characteristics, including: • Chief of Staff Model; • Chief of Staff and Vice President Medical Model; or • Chair of Medical Advisory Committee and Vice President Medical Model. • The common factor within all models is that each hospital is required to have a Chair of the Medical Advisory Committee • The Chair of the Medical Advisory Committee is appointed by the Board and is responsible for making recommendations to the board on the “quality of care provided in the hospital by the medical staff, dental staff, and midwifery staff and by the extended class nursing staff” • As a result, the Prototype Board-Appointed Professional Staff By-law sets out the duties of the Chair of the Medical Advisory Committee (removes references to a Chief of Staff position

15. Overview of Key Components Leadership Positions (continued) • While some hospitals have a Chief of Staff who sits as Chair of the Medical Advisory Committee, others operate under different leadership models.  • Significant detail around the different leadership models is set out in Appendix IVto assist hospitals in determining which model fits most appropriately within their organization, including: • Other duties and responsibilities that could be assigned to the appropriate person (Chief of Staff, VP Medical, Director of Care) who would report in to, and have their performance review carried out by, the CEO in respect of these duties • Considerations for hospitals on how to best structure this reporting relationship when the two roles are held by the same person, and the delineation between the reporting to the board (as chair of the Medical Advisory Committee) and the CEO (for other duties and responsibilities)

16. Part III – Implementation and Adoption

17. Implementation and Adoption Hospital Annual General Meeting • Requirement for hospitals to hold annual general meeting between the 1st day of April and the 31st day of July in each year on a day fixed by the board (section 9 of Regulation 965 under the Public Hospitals Act) Amending Current Hospital By-Laws • Generally, amendments are effective once passed by the board subject to confirmation of members • Board will need to consider which amendments will require member approval at the annual general meeting • Ministry of Health and Long-Term Care and/or LHIN approval is not required to amend hospital by-laws

18. Implementation and Adoption What Should A Board Do? • Conduct a review of current practices • Determine process for board and member approvals of by-law amendments • Consult with internal and external stakeholders, where appropriate, if board determines that amendments to current hospital by-laws are required • Ensure a transition strategy is in place, where appropriate, to move towards the adoption of new or amended hospital by-laws

19. Discussion 19