Knowing how your Chair operates is important but knowing how you want your Chair to operate is key.  We all have strengths, as well as limitations, and that is where teamwork begins.  What would the ultimate team look like between you and your Chair?

In our last issue we discussed preparing for your committee, which included information on the Committee Chair’s involvement with the agenda and moving the actual meeting along; now, let’s back up.  How do you get the Chair’s buy-in for the agenda items?  Many items on the agenda are “staples”:  initial appointments, reappointments, proctoring, etc.  But let’s get to agenda items that move Medical Staff Services forward, such as process improvements, policy enhancements or regulatory changes.

You might be having difficulty getting the Medical Staff to inform you of changes to their privileges.  Start the legwork by creating a policy and/or process that you think will work, then at your regular preparation meeting with the Chair, present your plan for discussion and comments.  Give examples on how the process will help the Chair in his/her role while enhancing the Medical Staff Services program at your organization.  Also, be prepared to compromise and do some revisions based on the comments you receive.  Once you have his/her buy-in, request the Chair present the policy/process at the next Credentials Committee meeting.  Support your Chair at the meeting by being prepared to answer questions other committee members may have about the process and then sit back and watch the positive changes take place.

We all have non-compliant practitioners that simply won’t do what we need them to do.  You’ve sent three letters and left a thousand phone messages (OK, a bit of an exaggeration).  Help your Chair support you by doing some of the work for him/her.  Compose an e-mail to send to the non-compliant practitioner then ask your Chair to forward it to the practitioner.

Most of the time an affective relationship between Credentialer and Credentials Chair is not getting the Chair to do the work but getting the Chair to buy-in to your work.  The last thing a Chair wants to do is spend time researching or writing process but if you can present a well thought out process getting buy-in should be fairly easy.

Communicating regularly and effectively with your chair will build trust and support between the two of you.  Support, as well as trust, is earned and a little work ahead of time will generally get you the support that you need.

One week prior to the meeting, get together with the Chair to review the agenda that you have developed.  This agenda should contain: Old Business - items that were not closed at the last meeting or required follow-up; New Business – items that the Chair or other members have brought to you since the last meeting; and Reports – regular updates from Administration, Nursing, or other Departments/Committees.  Meeting with the Chair helps the MSSP to be prepared for the discussion that will occur during the meeting and have the necessary supporting documents available.

Each agenda item should have a timeline to help the meeting progress, as well as letting you and the Chair know what can realistically be discussed at the meeting.  The MSSP can be the timekeeper for the Chair.  As time for discussion of an item is nearing the end, the MSSP can discreetly inform the Chair so (s)he can make the decision to table the item to the next meeting, call for a vote, or conclude the discussion.

Once the Chair has agreed to a final agenda, it should be distributed to all committee members in advance.  This provides the members with a reminder of the upcoming meeting and it also allows them to prepare for discussion of the agenda items.  Whenever possible, send supporting documents for agenda items as this provides members the opportunity to be prepared with questions and/or answers and allows the agenda to move much more smoothly and efficiently.

Two days before the meeting, call or e-mail the committee members to remind them of the upcoming meeting.  Although reminders may seem tedious and bothersome, it is worth the effort so that each meeting has a quorum and, if a quorum will not be present, provides the Chair the opportunity to make calls to influence the members to attend.  Also call the caterer to confirm your food order and ensure that delivery is scheduled for thirty minutes before the meeting start time.  Late meal deliveries can be disruptive to the meeting, causing delays and frustration, and this gives the impression of poor planning on the part of the meeting coordinator, the MSSP.

For the day of the meeting, be certain to copy enough agendas and packets for the committee membership.  If packets are sent in advance, bring copies for one-quarter of the membership.  Because there will not be enough copies to go around, over time this will ensure that the members bring their own packets.  (Caution:  Do this only with the approval of your Administration and your Chair because some may want you to bring enough packets for everyone.)  Arrive 30 minutes prior to the start of the meeting to ensure that the room is set up appropriately, the food has arrived, and distribute the agenda packets.  Now you can relax and enjoy your meal prior to the start of the meeting and this also gives you time to get to know the committee members who arrive early.

This time of year can create extra stressors for us. So how do we deal with it yet still enjoy all that the holidays have to offer? Well, the first step is to be aware that stress is lurking. Putting some methods into your repertoire now will prepare you for the thick of the holiday chaos!

Experiment with different relaxation methods such as meditation, visualization or deep breathing. Taking a few minutes in the middle of your day (or in the middle of a stressful situation) could drastically change your perspective and the outcome.

Close your eyes and concentrate on relaxing your toes. Work your way up to your head relaxing each section. Visualize yourself in an awesome place. Then, take a deep cleansing breath and move on with your day.

Another method to detach from your stress is to contract muscle groups. Go through several muscle groups contracting the muscle for a few seconds and then relaxing it. For example, you can squeeze a stress ball with your hand to help relax your forearms and wrists.

Do not underestimate a good deep breath. One good cleansing breath during a meeting might keep you from saying something you may later regret.

You can practice these stress reducers or invent some of your own. I’m no expert but these examples have been useful for many people. Quickly redirecting your attention is sometimes the best way to deal with what is going on, head on. Now on the count of three, take a deep breath and then let it go. One. . .Two. . .Three

First you need to decide how often to meet. Weekly meetings may be too much especially if they go long. Monthly meetings may not be enough. Get the staff’s opinion on the frequency of meetings. Whatever the decision, be consistent.

Type a template agenda with standard topics that can be left on or omitted for each meeting. This gives you a jumping off point and place holders for items easily forgotten. Some ideas are:

• Regulation/Accreditation/Legislation updates
• Policy changes (including department and organization policies)
• Training opportunities
• Work coverage for staff vacations or long term absences

Now set up a folder on a drive your whole department has access to and place the agendas, by date, in the folder so everyone can work on them. The team can add questions or issues directly to the agenda or request they be added by the person who is responsible for the agenda. Using this method, not only one person is responsible for the agenda topics and the meetings become relevant to everyone.

The last step is the meeting itself. Pose topics in questions which get group participation. Be open to comments and suggestions even though not all of them will be implemented. Staff meetings have a certain amount of announcement type agenda items but they should also be geared towards discussions when possible. If you can, bring bagels or donuts. I know I’m always happier when I’m eating!

Ask different staff members to conduct the meetings as well as present topics. The manager can be on the agenda as a presenter but not have to run every meeting and topic.

Besides regular meetings, an annual meeting is always a good idea. Here are some yearly topics to consider:

• Review of previous year’s accomplishments
• Discussion of goals for the next year
• Personal and Department goal writing and finalization
• Upcoming reorganizations or accreditation/regulation surveys (Major dates)
• Legislative updates
• Department measures/tracking
• Training (try to include training that will give employees CE credits)

Plan for at least 4 hours and include a fun “warm up” activity. Now I don’t mean jumping jacks. Not everyone is big on ice breakers but there is a lot you can do to get the brain waves clicking. Search for ideas on the internet, you’ll be surprised what’s available.

If time allows, let everyone wind down with an appreciation lunch. Don’t forget to have some follow up on the planning though and your regular staff meetings are just the place for continued discussions and progress checks.

Now go prepare and don’t forget to have fun. Work doesn’t always have to be a drag!

When you have hired your new staff member, give her a copy of the Medical Staff Bylaws and Rules and Regulations, practitioner application(s), and any other pertinent documents, then request that she review these documents and identify where the standards, laws, etc., are met in the documents.  This will accomplish at least two things:  1) the new staff member will learn, intimately, the Bylaws and Rules and Regulations so she can quote them “chapter and verse” or at least be able to locate the answer quickly when in a meeting, on a phone call, etc., and 2) these documents will undergo review from a fresh perspective.  Not only will the new staff member be able to identify areas where standards are not clearly met, but she will find typo’s that nobody has seen for the past 20 years!  Perhaps the biggest benefit of this process is that the new employee should attain a comfort level that often takes months, or even years, to achieve.

We realize your desire is to have your new employee “hit the ground running” because it is likely you have been trying to fill this position for some time and the work is piling up, but providing this opportunity should shorten the learning curve and will allow your employee to feel successful from the start.  If other priorities do not allow for the new employee to devote the first few days of her employment focusing on this task, set aside a couple of hours each day where she can go into another room to complete the review uninterrupted.  If reviewing for a couple of hours each day, she should be able to complete the process within a couple of weeks.

Please remember that when the new employee is conducting the review process, the manager should be open for questions.  Sometimes it may be difficult to find exactly where specific standards are met, so the manager should be certain to be available to explain where and how they are met, as well as accept recommendations for change.

For new employees who are responsible for meeting attendance, reading the minutes from the past two or three meetings should be required.  This will familiarize the employee with the Committee’s responsibilities, the issues that have been discussed recently and may be reviewed again during the upcoming meeting, as well as verbiage specific to the committee’s work.  This also provides the employee the opportunity to see how the minutes for the meeting have been written in the past.  Meeting with the Committee Chair to prepare the agenda will also be extremely helpful to the new employee and the Chair.

In addition to reviewing the Bylaws and Rules and Regulations, an effective method for training new employees on the credentialing process should include a review of credentialing policies and procedures as they often outline the entire credentialing process.  When the time comes for the new employee to process a credentials file, it helps to have a sample file.  The sample file can be one that you create specifically for training purposes, but there is really no need to go through the extra work of creating a file when you can pull the file of another practitioner in the same discipline.  These files will likely contain a majority of similar documentation that will be required in the new practitioner’s file.  Also, the use of a checklist will help to ensure that most of the appropriate documentation is in the file.  As we are all aware, it takes time to learn to identify those “red flags” that are sometimes hidden in responses, so having the manager or a trained staff member review the first several files will be invaluable to the new employee.  Also, the availability of the manager and/or other staff to answer questions will help.

Last but not least, encourage the employee’s continued learning.  One of the first steps may be to take a medical terminology course at the local community college.  Understanding what healthcare professionals are saying in their meetings goes a long way toward writing effective and meaningful committee minutes.  And, of course, as the employee continues to grow and be comfortable in her job, encourage certification as either a CPCS or CPMSM or both.

Before scheduling a face-to-face interview, have candidates go to the HR Department, just as they would for a typing test, and take a credentialing assessment test.  The test will consist of reviewing a mock-up file that should contain all of the required credentialing elements (e.g., application, license, affiliation verifications).  The responsibility of the candidate will be to review the file and note any deficiencies that you have created in this file.  Examples of deficiencies include an expired license, a missing affiliation verification, or a negative verification that requires follow-up but none was done.  These are just a few examples of items that should “jump out” at an experienced credentialing specialist.  Even if you do not have any candidates with experience, and are willing to train, it would not be a bad idea to briefly explain the credentialing process and have the candidates conduct the file review.  A candidate who pays attention to detail should be able to identify expired items or note that something may be missing because there are no pages behind a tabbed area.

The process of pre-employment testing in this manner could significantly decrease the number of interviews you conduct and can give you an idea of the applicant’s attention to detail, which is so critical in the credentialing arena.

Recognition can be big or small.  It doesn’t always have to be money and most of the time shouldn’t be.  Any gesture of “thank you” from the manager lets the employee know that you are paying attention and appreciate the work they do. 

Here are some things to consider while preparing your recognition plan.  If you haven’t noticed, people are different.  Some employees like public recognition and others are more private.  Consider the amount of fanfare you shed onto your unsuspecting staffer.  Our personal belief is that even employees who do not like public recognition need to be given it at times.  It is important for everybody to see the accomplishments of each team member but, at times, private recognition is appropriate.

You will need to consider what motivates your employees.  Some employees are motivated by a pat on the back during a staff meeting while others pull their motivation from being offered roles on committees or projects.  Take five minutes to write down what you think motivates your staff.  Also, it doesn’t hurt to hand out a small survey asking what personally motivates them as well as some personal preference questions so you can get to know your team (e.g. favorite color, hobbies, favorite munchies).  Knowing what they like helps to make your recognition more personal and meaningful.

Here are some ideas for individual recognition:

* Recognition certificate during a staff meeting

* Box of candy or candy bars (Consider a Score™ bar for a great presentation or a Snickers™ for being positive about a major change)

* A simple hand written Thank You note

* Leave work a couple of hours early, with pay (You may need to have this approved by Human Resources first)

* Lunch (Who doesn’t like free food!?!)

* A spot on a project team or the opportunity to present at a meeting

* A gift card (Starbucks™, Barnes & Noble™, etc.)

Appropriate timing and frequency need to be considered as well.  Recognizing an employee’s great performance six months after isn’t going to be as effective.  Create a spreadsheet with the names of your staff to keep track of when you recognized each staff member, the reason for the recognition and what was given.  Don’t forget, the recognition doesn’t just have to be individual; you can recognize your entire team for meeting that really tight deadline.

Team recognition ideas:

* Take them out to lunch or cater in

* Go bowling during the lunch hour (or 2)

* Throw an ice cream social or root beer float party

* Shirt with company logo

These are some ideas for you to consider.  The list can be long and varied. 

We would love to hear your success stories so please send us an e-mail to credchatter@lsmssc.com to let us know about your plan and how it worked out!  By the way, you’re doing a great job!

Also when conducting your file review, keep a list of all files with a Notes section next to each name.  Write down your personal notes regarding the files.  For example, if a file is perfect in every way, write “clean” or “no issues” next to the practitioner’s name.  If the file is OK, but there is just something slightly strange, write it down.  And the big one, if the file is missing a required element or an element was not obtained in a timely manner (e.g., a license was verified after expiration), make sure you make a note of it.  These notes are a private road map for you and your Administrator.

When you receive your list of files for survey,  take the time to go through each file and flag the documents that the surveyor will want to examine.   Many, if not all, of you have files that identify each section (e.g., application, DEA, license, education), but these sections can have pages and pages of documents in each of them.  Therefore,  flagging the pertinent documents is helpful to the surveyor.  If you can, place the flags in order starting with the first reviewed document flags at the top of the file and descending accordingly.  Mark each flag with the required element so you can turn directly to each piece of paper.  Believe it or not, surveyors appreciate the attention to detail and this allows the often slow task of file review to proceed faster.  This also provides you the opportunity for one final file review to ensure that you are prepared to answer questions the surveyor may pose.

Surprises are great but not during a survey.  If all of your files are in perfect condition, you won’t loose one wink of sleep (Other than the typical panic of whether or not your alarm will go off in the morning, even though it hasn’t failed you in the past 25 years!).  But, if it turns out that you do have an issue, be sure to prepare your Administrator by presenting the issue, as well as what you have done or are going to do to correct the problem for the future.  If the issue is identified by a surveyor during the file review, you are prepared to provide a confident response versus an “Ummmmmmmmmm”.

Don’t worry, everything will be fine.  Just take a deep breath and go!  Remember, you are the expert and you are PREPARED.

No time to develop a plan?  Give us a call.  We can evaluate your preparedness through an assessment that can include review of your files, bylaws, Policies & Procedures or any other area of concern, then help you develop your on-going readiness plan.

Just the mere thought of this task is enough to turn any good natured, easy going manager into mush!  So how do you get through it plus all the other mounds of work on your desk?  Simplicity!  None of us are perfect and as a manager it is difficult to call out someone’s faults even if they are basic.To make the task easier, choose the top three areas where each employee excels.  Next, select one (or two) areas where you would like each employee to improve.  By highlighting a small number of  concerns, you and your employee have a much better opportunity to achieve success.  If you have an employee that has many areas to work on, choose two or three major issues for the evaluation and work with your human resources department to manage the rest.When it’s time to present the evaluation, consider giving the document to your employee the day before you meet.  This gives the employee time to absorb the contents before the face-to-face.Now take a deep breath, you’ll get through this.  You always do!

We look forward to hearing from you!

Lynn & Sarah

LS Medical Staff Services Consulting, LLP