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In-house legal departments are continually expected to work faster, better, and cheaper — and nowhere is this more true than in the health care industry, where every dollar spent on overhead items such as legal services is a dollar not available to be invested in bedside care. My organization is no exception to this general rule. We are Central Texas’ largest health care delivery organization, with eight hospitals and more than 7,200 employees. Yet our legal department is relatively small, consisting of the general counsel (who is not a full-time legal services provider), three additional lawyers, a legal assistant, and two support personnel. With such limited resources, we have had no choice but to think carefully about how we can produce high-quality work as efficiently as possible. Our department has employed three primary tactics — none groundbreaking, but we believe they have significantly improved our ability to serve our internal business partners. • Set limits with your clients. Part of a legal department’s value is its ready availability to the organization, but that can be a double-edged sword, especially if the department is used inappropriately. A small department cannot function as a “business translator” for every written agreement or arrangement in which the organization is involved, nor can it indulge those who may believe that absolutely everything should receive legal review and approval. In either case, the legal department may put a stranglehold on the organization’s ability to do its business. Our team grappled with these issues, and we realized that many of our internal business partners didn’t know how to use the legal services department effectively. Our solution? We set limits with our clients — that is, we explicitly defined the scope of our work and communicated that scope clearly so that all of our internal clients have the same understanding of the limits of our resources and services. We accomplished this by issuing a new administrative policy, called Utilization of Legal Services, which was adopted by senior management two years ago. Basically, this policy describes what the legal services department does and doesn’t do, what steps should be followed by someone who submits a matter to legal services for review and response, and what time line our internal partners should expect for routine legal matters. The list of services provided is largely what any experienced in-house lawyer in a health care organization would expect: contract review; consultation on operational or patient care issues (including the legality of a proposed transaction); review and management of litigation issues; review of applications for licenses or permits (such as hospital or facility licenses, Medicare or Medicaid provider-number applications, etc.); review of administrative policies and procedures; and preparation of corporate documents (such as articles of incorporation, bylaws, corporate minutes, etc.). The list of services not provided is similarly clear and unsurprising. This list includes review of personal legal matters for network patients and network employees (including our officers and directors) and making final business or operational decisions. While this policy hasn’t eliminated every situation in which someone wants services we don’t provide, it has helped us manage the expectations of our internal business partners and limit our involvement to only those situations that most require the attention of a lawyer. • Educate your clients. We repeatedly found ourselves teaching and mentoring internal business partners who were inexperienced at negotiating and administering contracts. We also were frequently asked to take a more prominent role in negotiating business arrangements than our department’s size and resources permit. Coping with this degree of variability was a challenge, and we realized that it was reducing our overall productivity. We decided that we should educate our clients about the basics of contracting, as well as monitoring performance under a contract. So we created a new administrative policy called Contract Initiation and Administration, which was implemented in August 2000. Now, no one in the company may serve as a “contract owner” — that is, the employee having an identified business need and the ongoing functional responsibility for a specific contract — without first completing an education and training program on basic principles of contract negotiation and administration. This training program was developed by the legal services department and is taught by our lawyers on a rotating basis at least twice annually. The policy also clearly identifies situations in which a written contract is always required, as well as situations in which a written agreement is not required. Certain contracts that are more significant to our business for either operational or regulatory reasons — for example, any contract with a physician or allied health professional, or any contract with an insurance payor — are required to be in writing, while others are not. Finally, the policy requires that when proposed contracts are submitted for legal review, the contract owner must confirm that the contract draft contains the correct business terms and is complete (including all proposed schedules or exhibits). When contracts arrive for legal review, our department assistant reviews the form and the proposed draft. If key business information has been omitted or the draft appears incomplete, the contract is not accepted for review or is assigned to an attorney until the contract owner supplies the required information. This requirement alone has substantially benefited our department by reducing the time spent by our lawyers to locate missing information needed for complete legal review. • Find creative ways to expand your department’s reach. In the current operating environment, it is unlikely that we will receive budget authority to add department staff. Our quest, then, is to find ways to serve clients better with our current staff resources. As we focused on this task, we realized that department members were frequently handling the same questions: about consent for medical treatment (such as who can consent to treatment, when may consent be implied or inferred, etc.); whether the network had developed standard forms for certain transactions; and how (and where) to find applicable laws or regulations. We decided to create a more systematic way of dealing with these repetitive tasks and approached our information systems department about creating an intranet Web site for SETON Legal Services. With our department’s legal assistant serving as our webmaster, we developed the content for the components that make up our site. These include sections on frequently asked questions (such as consent to treatment) and links to relevant legal resources (such as for Web sites maintained by the Texas State Department of Health, the Board of Medical Examiners, and the Board of Nurse Examiners). In addition, we posted all our standard template forms and agreements on the site, so that our internal business partners can review and print them without contacting anyone at SETON Legal Services. Our site now averages more than 50 hits weekly. If each hit avoids a 10-minute phone call, then we may have gained nearly two additional hours of productive professional time each business day. In addition to our intranet site, in the past year we have begun publishing a quarterly electronic legal services newsletter featuring articles from members of the department on topics of interest. This quarterly newsletter is distributed to the members of our leadership team — approximately 175 employees holding positions at the director level or higher — by e-mail with a link to the newsletter’s posting on the legal services Web site. While the articles don’t provide true legal advice on any particular issue, in many instances they have prompted questions from our internal business partners that have given us the chance to intervene earlier in issues of potential concern. Each copy of our electronic newsletter also includes a customer survey tool, which asks our internal clients to provide immediate feedback on the usefulness of the newsletter and suggestions for future topics. Our clients tell us that our newsletter provides them with valuable information. These ideas aren’t revolutionary, and many in-house departments are probably doing similar things, as well as others we haven’t tried. But these relatively simple, low-cost actions have significantly helped our effort to provide better service to our organization — and we encourage other in-house counsel to look for those opportunities within their companies, too. This article was distributed by the American Lawyer Media News Service. Michael J. Regier is vice president, legal affairs, and general counsel for SETON Healthcare Network in Austin. His e-mail address is [email protected].

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