ZONE MEDICAL STAFF ASSOCIATIONS
IN THE MEDICAL STAFF BYLAWS AND RULES

The Bylaws and Rules govern the relationship between us and AHS. Below we outline the significance of these Bylaws and Rules and how we have a shared voice, responsibility, and accountability with AHS in these sections:

1)      Zone Medical Staff Associations (ZMSAs) Are Your Voice
2)      What the Bylaws and Rules Govern
3)      Your Inclusion in Governance
4)      Your Input for Changes to the Bylaws and Rules

Full documents are here: https://www.albertahealthservices.ca/medstaff/page7086.aspx

ZMSAs Are Your Voice

We are your representation for the Bylaws and Rules as per section 2.12 of the Bylaws. The purpose of the ZMSAs is “to facilitate the engagement and participation of the Zone Medical Staff in Practitioner-related matters, and the fulfilment of the responsibilities and duties of Practitioners pursuant to these Bylaws and the Rules”. There are five ZMSAs in Alberta, one for each zone.

What the Bylaws and Rules Govern

The establishment and description of:

1) the terms and conditions on which AHS may grant practitioners clincial privileges;
2) the responsibility of the medical staff to AHS for the quality and safety of all professional services provided by practitioners to patients and to AHS;
3) the responsibilities of the medical staff and AHS to each other for the organization and conduct of the medical staff, and in particular the processes relating to medical staff appointments and delineation of clinical privileges; and
4) the administrative structures (medical administrative leadership), committees and positions for the governance of practitioners working in AHS Facilities or other AHS Sites of clinical activity;

The creation, organization and operation of:

1) administrative structures, committees and positions for the governance of the Medical Staff;
2) granting appointments to practitioners as members of the medical staff;
3) granting clinical privileges to practitioners;
4) defining the responsibilities of all practitioners who are granted appointments and clinical privileges;
5) determining the accountability of practitioners for discharging the responsibilities related to medical staff appointments and clinical privileges;
6) establishing principles and process for the periodic review of practitioners; and
7) establishing principles and process for the triggered initial assessment, triggered review, and resolution of a concern, as well as the remediation of associated factors (if any) contributing to a concern.

Your Inclusion in Governance

Through the ZMSAs, the physician voice is represented and heard on a variety of committees:

1) The Medical Staff Bylaws and Rules Review Committee (Review Committee)

Each of the five ZMSAs appoints a member to the Review Committee. Additional medical staff representatives at large (equal to the number of Associate Chief Medical Officers) will be selected by the ZMSAs, after non-binding consultation with the Zone Medical Directors.

The purpose is to review the Bylaws and Rules at least once in each three year period from the date of the most recent adoption or more frequently as required, and to discharge all other duties assigned to it by these Bylaws and the Medical Staff Rules.

2) Hearing Committees

The ZMSA Presidents for the zone and Zone Medical Directors jointly select designates for a provincial pool of Hearing Committee members. Four shall be selected from each of the North, Central and South Zones, and nine designates shall be selected from each of the Edmonton and Calgary Zones. The thirty designates selected shall constitute a provincial pool of Hearing Committee designates.

A Hearing Committee shall be composed of three-five (a designated chair and two voting members) members, all of whom are drawn from the provincial pool of Hearing Committee members.

The purpose is to consider a concern referred to it in respect to an affected practitioner by receiving information and hearing evidence, and shall make recommendations.

3) Immediate Action Review Committee (IARC)

From the provincial pool of Hearing Committee members, a Zone Medical Director and ZMSA President jointly select a standing three person provincial IARC.

The purpose is to receive and consider all relevant information and evidence that led to the immediate action including any written submission from the affected practitioner, and prepare a report and recommendation regarding the disposition of the Immediate action in respect to an affected practitioner.

4) Provincial Practitioner Executive Committee (PPEC)

The five ZMSAs each send a member to sit on PPEC. The purpose is to consider, advise and report to AHS and the Chief Medical Officer on all matters at a provincial level pertinent to patient care and to the medical staff, and on all items referred to it, as well as issues including but not limited to:

a) quality and safe patient care;
b) interdisciplinary patient care and teamwork;
c) AHS service planning and delivery;
d) practitioner workforce planning;
e) practitioner satisfaction; and
f) all other responsibilities and duties assigned to it by the Bylaws and Rules.

PPEC also oversees the:

a) overall functioning ZMAC;
b) overall functioning of the Bylaws and Rules; and
c) AHS Provincial Clinical Department, Public Health.

PPEC may also establish subcommittees to assist in fulfilling its duties.

5) Search Committees

ZMSAs provide a member to participate on Search Committees.

The purpose is to make recommendations to the AHS medical administrative leader responsible for the appointment of a practitioner to the position in question. The medical administrative leader shall not be bound by the search committee’s recommendations. Search Committees will be for:

a) provincial level positions of Associate Chief Medical Officers, Senior Medical Directors and Zone Medical Directors shall be established by the Chief Medical Officer or designate;
b) zone level positions of Associate Zone Medical Director, Zone Clinical Department Head, Deputy Zone Clinical Department Head, Zone Clinical Section Chief, Facility Medical Director and Community Medical Director shall be established by the Zone Medical Director or designate; and
c) other Zone level positions may be established at the discretion of the Zone Medical Director.

6)      Zone Medical Administrative Committees (ZMAC)

ZMSA executive and members sit on the committee.

The purpose is to:

a) consider, advise and report to the Zone Medical Director and the PPEC on all matters pertinent to Patient care and to the
medical staff at the zone level and on all items referred to it. These matters include but are not limited to:
i) quality and safe patient care;
ii) zone-level service planning and delivery;
iii) zone input into practitioner workforce planning;
iv) interdisciplinary patient care; and
v) one-level interaction with respect to the Medical Staff Bylaws and Rules.
b) advise the Chief Medical Officer and Zone Medical Director concerning medical staff appointments, clinical privileges, and
changes to medical staff appointments and clinical privileges of the medical staff.
c) promote interdisciplinary teamwork.

7)      Zone Application Review Committee

ZMSAs provide two members.

The purpose is to review all initial applications to the medical staff and prepare a written recommendation (to accept, deny, or amend the application) after initial review by a Zone Clinical Department(s), and to review all requests to change a medical staff appointment and clinical privileges and prepare a written recommendation (to accept, deny, or amend the request for change) after initial review by a Zone Clinical Department(s).

Your Input for Changes to the Bylaws and Rules

Physicians provide input for amendments to the Bylaws and Rules through the ZMSAs.

Bylaws

The bylaws are reviewed by the Review Committee at least once every three years.

1) Proposing amendments: Amendments to the Bylaws may be proposed by the medical staff, AHS or the Review Committee. Amendments proposed by the Medical Staff are given to the Review Committee by the ZMSAs.
2) Committee agreement:
a) If the Review Committee unanimously agrees:
i) Vote: ZMSAs and the Medical Affairs Office coordinate a vote by medical staff. Two-thirds of the properly cast votes is
required for majority.
ii) Approval of amendments: If the amendments are supported, the Health Minister receives the amendments for
approval.
iii) Failed amendments: If the proposed amendments fail to have medical staff support, the Review Committee may:
- withdraw the recommendation and notify the party proposing the amendments;
- meet with the proposing party to revise the amendment; or
- request the proposed amendment be forwarded to the Minister for resolution. The Review Committee and ZMSAs
will provide a written opinion regarding the reasons medical staff failed to support it.
b) If the Review Committee agrees to support the proposed amendments by a minimum of two-thirds majority, but is not
unanimous in its recommendation, the party recommending the amendment will be notified. The party proposing the
amendment may:
i) withdraw the amendments;
ii) revise the amendments and send to the Review Committee; or
iii) request the amendments and written dissenting opinions of the Review Committee be forwarded to the medical staff
for a vote.
- Vote: ZMSAs and the Medical Affairs Office coordinate a vote by medical staff. Two-thirds of the properly cast votes
is required for majority.
- Approval of amendments: If the amendments are supported, the Health Minister receives the amendments for
approval.
- Failed amendments: If the proposed amendments fail to have medical staff support, and the amendments were
proposed by AHS, AHS may:
*withdraw the proposed amendments;
*revise the proposed amendments; or
*request that the proposed amendments, the written dissenting opinions of the members of the Review
Committee and the written opinion of the ZMSAs as to the reasons for the failure of the Medical Staff to support
it be forwarded to the Minister for resolution.
c) If the proposed amendments have less than two-thirds support from the Review Committee, the amendment will not go
to the medical staff for consideration. The Review Committee will notify the party proposing the amendment with reasons
and the decision.

Rules

The rules are reviewed by the Review Committee (provincial rules) and ZMAC (zone rules) at least once every three years.

1)  Recommending amendments:
a) Provincial rules: The Review Committee reviews the rules once every three years. Amendments may be proposed by any member of the Review Committee or any member of PPEC.
b) Zone rules: ZMAC reviews the rules once every three years. Amendments may be proposed by any member of ZMAC.
3) Review: PPEC receives all (provincial and zone) amendments to review and recommend for approval, amendment (if applicable) or rejection.
4) Vote: A notice of motion is necessary and must be given at a previous meeting or at least thirty days prior to the meeting. Two-thirds majority of those present and entitled to vote at any duly constituted meeting of the Review Committee (for provincial Rules), a ZMAC (for Zone Rules) or PPEC (for all rules).
5) Approval: The Executive Vice President & Chief Medical Officer receives the amendments for approval.

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The Bylaws and Rules lay an important foundation for our relationship with AHS. It is written in the Bylaws that “AHS and the Medical Staff jointly contribute to an effective medical organization structure through the development, implementation and amendment of Bylaws and Rules governing the creation, organization and operation of the Medical Staff”. The ZMSAs have been and continue to be your representation for input and the physician voice for the Bylaws and Rules.

Updated March 8, 2023