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Ways to stop lurching from crisis to crisis

Credentialing Resource Center Connection, November 12, 2003

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Dear Credentialing Colleague:

This week I received a telephone call from the chair of a California medical staff credentials committee. "When will the credentials process stabilize? With human disease I can usually predict that an illness will run its course and begin to resolve itself, but with credentialing I cannot," he said. He went on to recount his latest string of credentialing crises: the late Friday plea by a group to get a new "member" on staff by next Friday; the elderly physician who demands all past privileges at reappointment despite the fact that he no longer practices actively in the hospital; the request from a middle aged general surgeon for "weight loss" surgery privileges; cries from the anesthesiologists that a physician "outside their group" is doing pain management; a recent applicant with a record replete with gaps, disciplinary history, and a loss of license in another state; and my favorite, a written request from the "recruiter" to "set aside the board certification requirement" so that a recent "hire" could begin to work in the hospital's ambulatory clinic. 'Hold on I pleaded, over what period of time did these events occur?' His tongue in cheek reply: "Oh just last week!"

My e-mail to him later that day suggested the following:

1. Recognize the principle of delegation and chain of command. Most of the above scenarios are not credentials issues at all and instead they require policy direction from the medical executive committee (MEC) and Board.

2. Understand that the credentials committee is not expected to interpret exclusive contractual arrangements.

3. Understand and practice the concept of "burden on the applicant" and don't assume it is your problem if an applicant cannot provide complete information concerning past practice problems. (No info, no processing.)

4. Have management tell the recruiter to "get a grip and find qualified physicians."

5. Let the MEC know that the credentials committee needs direction concerning the hospitals plan for bariatric surgery.

6. Be compassionate and have a cup of coffee with this elderly retired colleague.

The crisis will pass when your hospital and staff recognize that most of your "credentials" issues are in fact complicated by the absence of policy. Remember and post the 5 P's: "It is our policy to follow our policy; in the absence of a policy it is our policy to create a policy." By return e-mail, he thanked me and said it really was OK; his term as chair ends in late December.

That's it for this week.

All the best,

Hugh Greeley

http://www.greeley.com/seminars/

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