MSA Roles

The Medical Staff Association:  What is it and why is it?

Traditionally, the opinions of the Medical Staff have been important drivers of effective care delivery in hospitals. Physicians are recognized as knowledgeable professionals who articulate what good patient care should be and who advocate for their patients.

Historically (and even today in smaller centres) physicians’ opinions and concerns were shared informally and freely with the management team; in large bureaucracies, however, this informal system is lost. As a result, Health Authorities, including Vancouver Island Health Authority (VIHA) with more than 18,000 employees and approximately 1,800 medical staff members, have established a more formal process to obtain such feedback and guidance. This process includes:

  • the Medical Staff Association (laid out in the Hospital Act and its Regulation as well as in the VIHA Medical Staff Bylaws);
  • the Departmental structure (established by the Bylaws); and
  • a system of Medical Managers/Program Directors, jointly established by the Island Health Executive Leadership Team, HAMAC and the Board of Directors.

While each of these groups provides physician input, they focus on different but overlapping functions:

  1. The Medical Staff Association (MSA)

Physicians are not employees of VIHA, but are independent practitioners holding a board-issued permit to provide care for patients in Island Health facilities. This permit delineates the work they can perform and the Department to which they are assigned. The rules under which such permits are issued are promulgated by the Board after consultation with the Medical Staff, including MSA representation on the Health Authority Medical Advisory Committee (HAMAC). They describe the relationship between the Board and the individual physician, and apply to all members of the medical staff. Under the aegis of the Hospital Act of British Columbia and the VIHA Medical Staff Bylaws, the Medical Staff Association is established to provide a collective physician voice, independent from Department Heads or Medical Managers.

The MSA is charged with representing the views of the medical staff on matters of interest to all medical staff. This includes advising the Board, through HAMAC, on the quality of patient care, its organization and provision within Island Health facilities. The MSA has a major role in identifying both the rights and responsibilities of the individual practitioner and ensuring that physicians can speak out freely, but appropriately, from a position of psychological safety.

The MSA plays an advocacy role that is independent from Medical Managers and Department Heads.  This is not intended to be oppositional, but to reflect the psychological reality that all of us, as well-meaning people, can sometimes become so caught up in our own beliefs or by administrative pressures that either we fail to see negative consequences that are visible to others or, alternatively, when change is needed but is met with resistance. The MSA can provide the independent voice of the medical staff as a whole.

The importance attached to these functions for the profession and the organization is emphasised by the fact that, under the Bylaws and Rules, all privileged physicians — without exception — must belong to and participate in the MSA. Like Department Heads, MSA representatives sit on HAMAC and the local MACs as voting members.


  1. The Department Structure

The Medical Department, through its head, is responsible for setting, maintaining and adjudicating the standards of medical care delivered to patients and residents in Island Health facilities. In any specialty, reasonable and up-to-date standards are established by those most familiar with what they should be, namely a group of peer clinicians. This is also the group best able to identify who has obtained and maintained their qualifications to provide an appropriate level of patient care.

Physician leaders, through the local Medical Advisory Committees and HAMAC, are accountable to the Chief Medical Officer, the Chief Executive Officer and the Board of Island Health for these standards.

These accountabilities require a strong relationship between the Department, which sets standards, and the medical administrative leadership, who operationalizes them. In Island Health the same individual frequently fills both functions – Department Head and Medical Manager. When this combined position works well, it addresses many practical concerns; however, it does require continual clarification and balancing between departmental standard-setting and the reality of budget processes and availability. Serving two sometimes-conflicting interests can be difficult. In smaller centres, where everyone knows everyone else and relationships are informal, questions and concerns can be more easily raised. In larger centres, where such personal contact may be diminished, the Medical Staff Association can offer consultation and assistance.


  1. The Physician Medical-Manager/Program-Lead Structure

These are physician operational leaders within Island Health who reflect Departmental standards of care on administrative and clinical teams so that Island Health programs meet the standards of care our patient community should expect.

This task ­­- to ensure care in a program responds to the patients’ clinical needs and changes in clinical knowledge, all in the context of a fixed budget and potential political constraints – is challenging. Done properly, it provides better direction of how clinical dollars should be spent.

Better patient care demands high clinical standards and clear, thoughtful operational decision-making. This requires a collegial Medical Staff that is vigorous and engaged, as well as confident in its ability to advocate in a psychologically-safe environment. It also requires the establishment of safeguards that prevent issues from going awry.  Maintaining that atmosphere and those safeguards, through your collective voice, is the raison d’être of your Medical Staff Association.

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