MSSPNexus Blog

Hospital specialists assume national and state leadership roles

From The Indy Star - Submitted by Joe Steuteville

Two St. Francis Hospital & Health Centers staff members have been elected to lead a national and state chapter of medical service professional organizations.

Janet O'Hair recently was elected president of (the) National Association Medical Staff Services and Belinda Sherlock is the president of the Indiana Association of Medical Staff Services. Their elections mark the first time two professionals from the same health-care facility have simultaneously led the organizations.

Read the rest of the Indy Star article

More Gems from the Estes Park Institute Healthcare Conference

Here are a few more tidbits from my Estes Park Institute conference notes:

Collegial Intervention:

• The suicide rate for male physicians is 1.5 X higher than the general population.
• The suicide rate for female physicians is 2 X higher than the general population.
• Collegial intervention programs can help.  Develop policies that encourage early intervention by medical staff leaders, and procedures that legally protect their efforts.

Conflict of Interest:

• When a member of a voting body has a conflict of interest with regard to a matter under consideration, not only should the individual refrain from voting on the matter, they should leave the room (or be asked by the Chair to leave if necessary) prior to any discussion about the issue.  Minutes should reflect that the individual with the conflict left prior to any discussion.

Environment of Care:

• The need for medication prescribed to modify mood and behavior was significantly reduced (40% or more) when a nursing home was redesigned to be esthetically pleasing and comfortable, suggesting the enormous impact our environment has on wellness and healing.

Leadership:

• The higher an individual's rank in an organization, the less honest feedback they can expect to receive, both positive and negative.  Leaders must find ways to seek and reflect on feedback.

Legislation:

• The Patient Safety and Quality Improvement Act was passed in 2005.  The open comment period for rules ended 4/12/08, and final rules are expected to be published by the end of 2008.

Risk Management:

• Presenters encouraged timely group debriefing after a near-miss event.  If something adverse almost happened, what prevented it?  If it was prevented simply by chance, not by fail-safe measures, prompt redesign can be facilitated by the group.
• When recommending process changes, defer to knowledge and experience over rank.

Future Directions:

• Web-based healthcare is literally, just around the corner.  One presenter forecast that within five years web-based subscription healthcare, paid for in nominal monthly fees, will serve as a resource for basic health information and physician referral.  Patients will use these services as a way to manage and coordinate their care. The repeatedly asked question was, "Will patients receive this information and referral service from your organization or from someone else's?"

DNV Healthcare Seeks Deemed Status from CMS

In 2006 this blog commented on the application for CMS deemed status by Ohio-based TUVHS. We didn't hear much about the application after that, but now we know that TUVHS was bought by DNV (Det Norske Veritas), an international certification body, and an application for deemed status has now been submitted to CMS by DNV Healthcare.

From the DNV Web Site:

DNV continues its expansion and focus on healthcare through the formation of DNV Healthcare Inc. and by acquiring TUVHS, the US based organization providing hospital accreditation to the NIAHO^SM program. 

This latest development fully supports DNV’s initiative to gain deeming status from the Centers for Medicare and Medicaid (CMS) in the US and to provide US hospitals with an alternative hospital accreditation option.

If approved, DNV stands to become the first new option for hospital accreditation in over 40 years. Information about DNV’s application and the need for alternative accreditation is available at www.newaccreditation.com.  Deadline for comments to CMS about the application is May 27, 2008.

http://www.dnvcert.com/DNV/Certification1/Services/HealthcareServices

http://www.dnv.com/press_area/press_releases/2008/dnvhealthcareadvances.asp

The Role of Senior Leadership in Credentialing, Clinical Privileging, and Peer Review

Effective, thorough practitioner credentialing, clinical privileging, and professional peer review are vital components of safe patient care.  The importance of these complex functions is being reinforced this week at the Estes Park Healthcare Leadership conference. 

This conference attracts senior executive, board, and medical staff leaders from hospitals around the country.  Program topics include strategic planning, financing, legislation, technology, patient experience, medical staff relations, and yes, credentialing, privileging, and peer review. 

Sessions led by Charlotte Jefferies and Linda Haddad, Senior Partners in the law firm of Horty Springer, provided these items of note:

Credentialing/Privileging

• Make sure any privilege criteria developed is specialty specific, not department specific.  Department-specific criteria may lead to anti-trust allegations.
• Encourage recruiters to work closely with the medical staff office.  Recruiting a physician who does not meet the hospital's application criteria can create difficult and expensive problems for an organization.
• Associate any requests for temporary privileges with a well-documented patient care need.
• Share all pertinent information discovered during the credentialing/recredentialing process with the ultimate decision makers, i.e., the Governing Board. 

Peer Review

• Develop objective measures for actions and outcomes controlled by physicians.
• Share credible data routinely, not just when a problem arises.
• Remember that an organization cannot manage what it does not measure.
• Encourage early intervention by by medical staff leaders.
• Review concerns and findings with the affected physician, provide ongoing feedback.
• Establish the source of authority and responsibility in peer review matters by advising physician leaders to respond on hospital, not personal, letterhead.

And for both, developing and following well-formulated policies can save the day.