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The human element

Credentialing Resource Center Connection, August 21, 2008

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Sally J. Pelletier, CPMSM, CPCS, is a consultant with The Greeley Company, a division of HCPro, Inc., specializing in the areas of credentialing and privileging.

Dear credentialing colleague:

Unfortunately, at some organizations, I find that perfunctory reviews of credentials files are still taking place. Rarely is this due to a lack of either caring or conscientiousness on the part of the reviewers. Instead, this cursory evaluation may be due to a lack of education and appropriate orientation related to best practice credentialing. This lack of proper training leads to a misunderstanding about the importance of the credentialing and privileging function, which in turn leads to a less-than-stellar process.

Other reasons for performing a mechanical or unthinking review could be due to:

• A lack of sufficient resources in the medical staff services department or credentialing office resulting in a continuous crisis management mode of operation
• Medical staff leaders encumbered with an inefficient and dysfunctional credentialing process (e.g. lack of a confidential area to review files, no opportunity to review the file prior to a meeting where the expectation is that some action will be taken)

Either of these scenarios can result in a rote review of a file at one level or all levels (from MSP, department chair, credentials committee, and MEC) based on reviewing a checklist of verified information (e.g. current license, malpractice coverage, DEA, correct number of professional references received, etc)..

Whether it is the MSP conducting an initial analysis of an applicant’s file, or the department chair, credentials committee, MEC or medical director making recommendations related to the granting of appointment and/or privileges, those involved have tremendous responsibilities to protect patients, and for overseeing the credentialing and privileging process. If you find that a mechanical review of credentials files is occurring at your healthcare organization, it is time to introduce—or perhaps reintroduce—the human element.

My Dad recently completed a very lengthy stay in the hospital. All of us either have first hand experience as inpatients or have someone close to us who has been one. I certainly hope that everyone who provided my Dad with care (and those who credentialed the practitioners who provided him with care) recognized the importance of making the human connection.

How do you ensure that the human element is the driving force behind your process?

For credentialers, instead of centering your attention on verification checklists (useful as they are), handle each file with the human element in mind:

• Review the applicant’s history with an interest in each and every event and how those events link together (or don’t link together). Look for gaps and seek explanations for those gaps.
• Communicate regularly with the applicant about the status of the file. An added bonus would be to do this by phone—a personal connection—followed up by an email. After all, this individual will more than likely be one of your co-workers one day soon. Make them feel welcome and important as an individual.
• Tackle each file with the patient first and foremost in your mind.

Healthcare organizations also have a responsibility to remember the human element and should make sure that the process itself considers all who are involved by:

• Adequately supporting and staffing the medical staff services department
• Appropriately training and supporting the individual medical staff leaders who are making credentialing and privileging decisions

There are several detectives from TV history known for having the ability to go the extra mile, or who had a particular nose for finding details that others previously missed: Magnum PI, Rockford, Kojak, Mannix, and Columbo, among others. Recently, a chief medical officer (CMO) who needed to fill an opening in the medical staff services department informed me that he needed a “Columbo” for the spot. Columbo definitely knew how to analyze a case with the human element in mind. When others were pursuing the more obvious evidence, Columbo was busy looking at small clues that many people would not notice.

A credentials committee member recently asked me, “How do you know what to look for when analyzing a credentials file? A future article will address how to fine tune your organization’s credentials file analysis.

Remember, credentialing has no other master than the patient.

That’s all for this week.

All the best,

Sally J. Pelletier, CPMSM, CPCS
http://www.greeley.com/consulting.cfm

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