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Adv Chronic Kidney Dis. 2018 Nov;25(6):499-504. doi: 10.1053/j.ackd.2018.03.004.

Leading the Dialysis Unit: Role of the Medical Director.

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University of Cincinnati, Cincinnati, OH; and Indiana University Health, Indianapolis, IN.
University of Cincinnati, Cincinnati, OH; and Indiana University Health, Indianapolis, IN. Electronic address:


The responsibilities of a dialysis unit medical director are specified in the ESRD Conditions for Coverage and encompass multiple quality, safety, and educational domains. Many of these responsibilities require leadership skills that are neither intuitive nor acquired as part of the medical director's training. An effective medical director is able to shape the culture of the dialysis facility such that patients and staff feel free to communicate their concerns regarding suboptimal processes without fear of retribution, and there is a continuous iterative process of quality improvement and safety, which values input from all stakeholders. This ultimately decreases the use of shortcuts and work-arounds that may compromise patient safety and quality because policies and procedures make it easiest to do the right thing. Fundamental to this leadership by the medical director are communications skills, staff empowerment, allocation of resources, mentoring, team building, and strategic vision. The medical director leads by example and must be present in the dialysis unit for extended periods to send a message of accessibility and commitment. Many dialysis medical directors would benefit from leadership training inside or outside their dialysis corporation.


Dialysis; Leadership; Medical director; Quality; Safety


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