Preventing Preventable Headlines: 5 Credentialing Essentials That Can Safeguard Patient Safety

4 minutes

What’s Trending: Practitioners with Histories, Nurses With Fake Degrees

You’ve probably seen the headlines: Elderly patients have lost limbs or lives following unnecessary medical procedures with physicians who have criminal records. Young mothers in labor have died in the delivery room from reckless anesthesia procedures. And thousands of fraudulent nursing degrees have hit the market. 

The headlines are horrifying. 

As a leader at an ambulatory facility, a telehealth agency, or a health system affiliated with other provider entities, you may rightly be worried that an incident like this could happen at your organization as well. The good news is that putting the right credentialing protocols in place can safeguard what’s most precious—your patients’ safety, your organization’s reputation, and your practitioners’ wellbeing.

Why It Matters: Credentialing Without Rigor Can Cost Lives

Credentialing processes without sufficient rigor can allow risky professionals to provide patient care and put your organization at risk for negligent credentialing. From landmark cases such as Darling vs. Charleston and Johnson vs. Misericordia to arresting headlines of more recent years about fake nursing diplomas in Florida, vascular surgery clinics in Arizona, and Dr. Duntsch (“Dr. Death”) in Texas, credentialing without rigorous safeguards can have a dramatic and negative impact on patients’ lives. 

Ambulatory and other for-profit provider organizations seem to most frequently feature in stories of patient harm—in large part because they are less regulated than hospitals and health systems. But leaders responsible for credentialing at hospitals and health systems should also take note and ensure that they are following not just the minimum requirements but also the best practices for credentialing. Patients’ lives and wellbeing hang in the balance. 

What’s Next: Ensure Your Organization Embraces These 5 Credentialing Essentials

Credentialing that safeguards your organization’s reputation and your patients’ safety is all about following best-practice process and structure. These 5 elements are essential:

1. Focus on the Process

It should go without saying that no practitioner should be allowed to provide patient care until they have successfully satisfied the requirements of a stringent qualification, or disqualification, process. Begin by collecting the appropriate information (i.e., formal education, training, and certification). Then verify through primary sources that the information the practitioner provided is valid.

2. Streamline and Standardize the Steps

Since the ultimate goal of any provider is to deliver the best patient care possible, healthcare organizations must streamline and standardize the credentialing process by: 

  • Optimizing technology.
  • Developing and consistently implementing agreed-upon verification elements and eligibility criteria.
  • Effectively aligning the workstreams of recruitment, credentialing, and enrollment. 
  • Revisiting and re-evaluating the process regularly to ensure optimal results. 

Screening incoming physicians and assigning appropriate privileges can be a time-consuming task even under the best circumstances. The more streamlined and integrated your processes are, the sooner you’ll have the appropriate physicians caring for patients whose conditions fall within their specialties.

3. Think About—and Look for—What You Don’t See

When you’re evaluating a credentials file, having all the appropriate documents is important, but that doesn’t necessarily give you the whole picture. Sometimes what isn’t included in a physician’s background document is equally as important as what is included. It often takes a highly trained credentialing expert to pick up on what could be important nuances in an applicant’s file. 

4. Ensure You Have Appropriate, Highly Trained Personnel

Lack of credentialing and privileging success is almost always due to improper or incomplete training, or insufficient personnel and resources. Sadly, incomplete or erroneous processes or decisions based on incorrect information (and the resulting faulty certification of physicians) can easily compromise patient care. 

Taking the appropriate steps to avoid risk is imperative. To do that, you need the right, most highly trained staff possible. When that proves difficult due to internal staffing limitations, it may be appropriate to seek outside help from a trusted organization with a long history of credentialing and privileging success.

5. Get Buy-in at Every Level

We’re not just talking about properly training credentialing staff either. It’s also hugely important that your physician leaders, committee members, senior management, board members, and other leaders all understand the complexities of credentialing and privileging and the importance of implementing the processes necessary to get it right. Obtaining their buy-in at the beginning will kick off your process improvement initiative on the right foot and improve your chances of success.

Safeguarding Against Negative Outcomes Also Produces Positive Ones

For healthcare organizations that perform credentialing the right way, the results are substantial. In addition to avoiding the negative situations like those described earlier, organizations with a healthy credentialing program can reduce costs and risks to both patients and the institution, realize quicker performance, enhance revenue and—most importantly—improve patient care. 


© 2023 Chartis Clinical Quality Solutions. All rights reserved. This content draws on the research and experience of Chartis consultants and other sources. It is for general information purposes only and should not be used as a substitute for consultation with professional advisors. It does not constitute legal advice.

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