The “Medical Staff Organization Manual” or “Committee Manual” is one of the most important, but rarely discussed, Medical Staff governance documents. It is often drafted as a standalone policy, outlining the Medical Staff’s existing department structure and medical staff committees (composition, duties and responsibilities, and meetings, reports and recommendations). Revisiting the content of the Organization Manual periodically provides an opportunity for Medical Staff leaders to carefully assess their current departments and committee structures to determine whether they continue to work for the organization. Medical Staffs that are part of growing systems, or which have recently unified, may want to consider whether the Medical Staff would be better served by committees that represent the entire system (e.g., a system Credentials Committee) and, further, whether any committees (whether specific to the hospital or system-based) should be modified in order to make the work of the Medical Staff more effective and efficient, or to include representation more reflective of the modern Medical Staff (e.g., ambulatory representatives, campus-based representatives).