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Adopting HR procedures in credentialing

Credentialing Resource Center Connection, August 5, 2005

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Dear credentialing colleague:

The credentialing process for a critical care physician involved in providing patient care in a critical care unit is generally very meticulous and complete. The medical staff office must confirm the applicant's background in great detail, including primary source verification of education, training, experience, clinical competence, work history, disciplinary history, and (in many hospitals) the applicant's clinical background with external organizations. All this is done in the name of patient care, and while it could probably be accomplished more rapidly, it is necessary to assure that only high quality practitioners are appointed and permitted to provide such complex care. Once appointed, this critical care physician would not generally have the opportunity to sit with his or her supervisor or department chair to discuss performance during the appointment period unless it was deemed inadequate. In fact, it's quite possible no one would provide any personal periodic feedback to the physician.

Now consider the registered nurse (RN) who applies for a job as a critical care nurse. In most facilities, no references addressing current clinical competence would be obtained, and work history would be verified only to the extent that others chose to provide information. Often, if an employee had had prior disciplinary action or clinical problems, such information would not be communicated to the next employer. However, in most hospitals, the RN would be required to participate in a specific orientation process, be subject to initial concurrent supervision, participate in rigorous monitoring by a supervisor, and would be required to have a health examination prior to commencing work to be sure that patients were unlikely to be infected or otherwise compromised.

To achieve the highest level of quality care, the best of both of these processes should be combined into one. Clearly, if letters of reference attesting to competence are needed to ensure the safety of clinical care physicians, the same should be true of RNs. Similarly, if an RN needs a health examination and various tests to minimize the possibility of patient injury, the same should be true of a patient care physician.

Some might suggest that it is impossible to obtain a reference questionnaire concerning a previously employed nurse. I believe this is untrue. Human resources departments could adopt exactly the same techniques utilized in the medical staff office regarding such information about applicant physicians . Others might suggest that asking a critical care physician to submit to a health examination or specific tests would be an unwarranted invasion of the individual's privacy. In response, I would only say that what is good for the goose is good for the gander.

That's it for this week.

All the best,
Hugh Greeley
http://www.greeley.com/seminars

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