Credentialing & Privileging

HR can take a lesson from credentials professionals

Credentialing Resource Center Connection, February 9, 2004

Want to receive articles like this one in your inbox? Subscribe to Credentialing Resource Center Connection!

Dear Credentialing Colleague:

For too long, there has been a double standard when it comes to processing applications for appointment to the medical staff as opposed to processing applications for employment by the hospital.

Credentials committees require an exhaustive background check, including verification of the medical staff applicant's past practices and hospital affiliations, and receipt of precise professional references attesting to his or her skill, judgment, knowledge, ethics, completion of records, and overall quality of care. Credentials committees also verify the reason a practitioner left a prior practice, and whether he or she was subject to disciplinary action, an investigation, or resigned to avoid such an investigation.

Indeed, due to concerns about "state hopping," a practice whereby a physician having or facing disciplinary action simply moves to another location, the federal government created the National Practitioner Data Bank (NPDB). The NPDB requires all health care facilities to report all actions taken by hospital boards against physicians, including licensure restrictions, malpractice payments, and disciplinary actions.

Hospitals heeded concerns about incompetent practitioners and began to exercise greater scrutiny when reviewing medical staff applications. Instead of relying solely on references provided by the applicant, they began to insist on professional references from designated individuals with knowledge of the applicant's past practice.

The combination of data bank information and precise background verification of medical staff applicants has made it far more difficult for an incompetent physician to obtain staff membership and privileges.

Today it is time for the human resource (HR) department to borrow the best practices that have served medical staffs so well.

Recent events, including the case of a New Jersey nurse who claims to have killed 30-40 patients, show that failure to conduct an adequate background check of health care workers may have exposed the public to workers who intentionally injure patients. Hospitals should protect the public by assembling and verifying information regarding past work experience prior to employment.

What are the barriers to such a proposal?

1. Lawyers may continue to advise their client hospitals to confirm only dates of employment and nothing else. The philosophy here is: "You can't be sued for what you don't say."

Let us debunk the myth that hospitals face liability for disclosing factual information concerning a past employee.

Hospitals could require all potential employees to sign "releases," which shield the requesting party from a lawsuit filed by the applicant in conjunction with review of an application, as long as no malice is present. Such releases also request and authorize release of information to be used in the application process. This is standard practice for physicians and there is no logical reason why the technique cannot be modified for use by HR departments.

2. Careful screening will slow the process of hiring and in a competitive labor market the competition will not be so choosey and the hospital's labor force will suffer. Nonsense and poppycock. Patients are the reason hospitals exist and their protection must come first. National standards would level the playing field and prevent Hospital A from snapping up the available supply of nurses to the detriment of Hospital B.

3. This is overreaction. We should not let a small number of "bad apples" change a system that has worked well for decades and we should not let recent events cloud the reputation of all the highly qualified, caring health care professionals seeking employment.

Physicians have made this argument for years: "Why go through all this process when there are so few incompetent physicians out there?" History and research has taught us that there are indeed a very small percentage of physicians (perhaps as low as four to seven percent) who for some reason are no longer either qualified or competent. Unfortunately, this small percentage translates into between 30,000 and 60,000 individual practitioners.

There is no reason to assume that the millions of other health care practitioners are free of the same illnesses (drug and alcohol abuse), and competence or behavior problems that surface within the physician population. Assuming that competency/qualification problems are present half as often among the ranks of nurses, physical therapists, respiratory therapists etc, the resulting number is easily more than 100,000 individuals with something disturbing in their background that a supervisor would like to know about.

That's it for this week.

All the best,

Hugh Greeley

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



Want to receive articles like this one in your inbox? Subscribe to Credentialing Resource Center Connection!

Most Popular

Related Articles