La Pine: Reading comprehension, pt II

Reading Comprehension – Solution to previous challenge

A previous posting presented a challenge for our reading comprehension skills. We were asked to read the first paragraph of the Declaration of Independence and then summarize it is 15 words of less. Here is one of the possible solutions:

When a people decide to separate politically, respect for others mandates an explanation.

How did you do? Remember less than 50% of the population could solve this on the first attempt.

Carole La Pine, MSA, CPMSM, CPCS

Hendrickson: An anxious time of year for residents, med staff offices

La Pine: Positive recognition can come from anyone

There is a question we are asked each year as part of our Gallup Survey: In the last seven days, I have received recognition or praise for doing good work. We are asked to rank our answer on a scale ranging from Strongly Disagree to Strongly Agree (1 – 5). My guess is that MSPs aren’t hearing words of praise from medical staff leaders. So to given staff positive feedback, we have not limited the recognition or praise to medical staff leaders only, but include our peers, co-workers and external customers. That can make a big difference in the score!

One important group that doesn’t get the feedback from this question on the Gallup Survey is our Credentials Committee members. Do you think medical staff leaders ever given recognition or praise to the Chair or members much less in 7 days! Well, perhaps when the member is being recognized for his/her retirement at the annual medical staff dinner.

Since that positive recognition can come from anyone, why not thank your committee at your next meeting … it may get them wondering what you are up to!

Carole La Pine, MSA, CPMSM, CPCS

The Joint Commission Surveyor Presentation

What will The Joint Commissions be looking for on your next survey?

I had the opportunity to attend the Alaska Association of Medical Service Professionals 10^th Anniversary Conference held in Soldotna, AK on June 11-13. One of the speakers was a physician surveyor for The Joint Commission and he shared with us what surveyors will be reviewing the next time around.

At this point in time we are still uncertain of the impact MS.1.20 will have on our medical staff offices as to the Elements of Performance that may affect our medical staff bylaws. MSPs hope that we will not be required to include the details of the credentialing and privileging procedures in the bylaws but be allowed to house those in appropriate policies and procedures.

One thing is certain; there will be a totally new numbering system for all the standards. I’m considering myself fortunate that I did not memorize all the current numbers or I’d be on brain-overload by December 2009. The 2009 standards will be available on-line at TJC’s web site by September 2008. I have been assured that there are NO new standards only a more logical flow in the new format.

Here are some of the key elements that surveyors will be looking for on the next survey:

1. Privileges

If your facility is using “core” privileges, there must be a listing of what is included in that grouping. Those physicians who wish to delete a core privilege must be allowed the opportunity to do so by crossing it out.

2. Health Statement

Applicants will still make a statement regarding health status and any problems that could affect his/her ability to perform a specific privilege BUT that must be confirmed (each facility will determine how this will be implemented).

3. Focused Professional Practice Evaluation

Is there a clear description of the process for FPPE for new privileges, both for initial requests and for new privileges? Is the trigger criteria clearly defined? Is the proctor plan in place with appropriate documentation?

4. Focused Professional Practice Evaluation

Is there a clear description of the process for FPPE for new privileges, both for initial requests and for new privileges? Is the trigger criteria clearly defined? Is the proctor plan in place with appropriate documentation?

Those are the highlights from my notes. The more I hear about these standards, the more I start to understand it. And that makes me just a little nervous … am I really getting this?

I shared this information with my Chair of our Credentials Committee and his response was, “Well, that’s one surveyor’s viewpoint”.

I wish us all the best on our next surveys and I’m keeping my fingers crossed that I won’t be the first!

Carole La Pine, MSA, CPMSM, CPCS

La Pine: What job skills will you need in the future?

Job Skills to Succeed in 2010 and Beyond

Wonder what job skills you will need in the future? Here are some “soft skills” that top the list:

1. Listening – sounds so easy, but really is a key component

2. Communication, especially in different modalities. Strong speaking and writing skills are important to effective communication

3. The ability to work as part of a team. This includes accepting the leadership role as well as developing trust, both in others and in yourself.

It is skills such as these that indicate a positive attitude and can make you a valuable and trusted employee.

How can you distinguish yourself from other competing in the work place? By using your interests and passions you can demonstrate your abilities to lead. For example, volunteer to be involved in your community, church, or professional organization, demonstrating your initiative to accept challenges.

Self-assessment can be a powerful exercise to consider what major accomplishments you’ve made, what successes you’ve had so far in your career.

Key point: Employers are looking for leadership abilities; the passion that can inspire and motivate others.

There are several things you can do to hone your skills:

1. Find a mentor (or become a mentor)

2. Take advantage of certification programs

3. Continue your professional development

4. Keep up with your professional field by seeking information (reading, online programs, networking with others in your profession, etc.).

And last, accept change. Use your skills to work toward making improvements.

Carole La Pine, MSA, CPMSM, CPCS

Henrickson: Moderate sedation privileges

Our Moderate Sedation requirements currently require the completion of a Moderate Sedation Analgesia Training Program (the standard required guidelines and hand written test). We recently stepped up our requirements to include the completion of a course in BLS, ACLS, ATLS, PALS or NALS (we wrote in a provisional exemption for those physicians with advanced training in airway management and resuscitation techniques). Taking into consideration the value of a physicians’ time (and energy!), we wanted to accommodate them with a way to meet this requirement.

When reviewing what training sessions are available – such as seminars or in-services offering the BLS, ACLS, ATLS, PALS or NALS, some dates and times did not seem to accommodate the physician schedules. In searching for alternative ways to provide an adequate and acceptable training for moderate sedation, we found a video addressing Positive-Pressure Ventilation with a Face Mask and a Bag-Valve Device from The New England Journal of Medicine. We will suggest this as another way to complete our newly added requirement for the Moderate sedation privilege.A link to thevideo isincluded below.

http://content.nejm.org/cgi/video/357/4/e4/

La Pine: Aren’t we really doing investigations?

I’m getting ready to do a presentation to the Alaska Association Medical Staff Services next week. My topic is “Red Flags”. As I was looking at the examples I’m going to use it occurred to me what a unique role we have in this “investigation” process. I know we use the term “credentialing” but aren’t we really doing investigations?

Taking that into consideration, how would that impact our current job titles? Director, Practitioner Investigation and Privileging Department
Manager, Quality Investigation Service
Medical Staff Investigator
Health Plan Practitioner Investigator

Oh the possibilities! Think the patients would have a better understanding of our responsibilities?

Carole La Pine, MSA, CPMSM, CPCS

La Pine: Questions about healthcare are not isolated to the USA

Questions about theadequacy ofhealthcareare not isolated to the USA. Here is an interesting item from the New Brunswick Inquiry reported in the Globe British Columbia newspaper.

A review of surgical pathology practices at the Miramichi Regional Hospital identified problems with Dr. Rajgopal Menon’s ability to trim surgical pathology specimens properly due to visual problems. Health officials reviewed 227 breast and prostate cancer tests from 2004-05 diagnosed by Dr. Menon. Eighteen per cent of his readings were found to be incomplete leading to a re-examination of nearly 24,000 cases he handled between 1995 and 2007.

Dr. Menon underwent cataract surgery in December 2006. Prior to that time he had difficulty with his vision during specimen trimming processes that were observed by laboratory assistants. Dr. Menon, 73, did not disclose his surgery to the hospital staff.

“Given the importance of vision to a pathologist, the College of Physicians and Surgeons of New Brunswick may wish to consider whether or not this represents an ethical and/or legal failure to disclose a significant medical problem”.

Do we consider vision exams for our pathologists? Should we?

Carole La Pine, MSA, CPMSM, CPCS

La Pine: New changes on the way from The Joint Commission

Coming Soon from The Joint Commission: New format, new numbering system, and more logical layout.

The Joint Commission’s (TJC) Standard Improvement Initiative (SII) will be bringing a new, logical structure to the manual chapters. The manual will also have a new numbering format designed to allow electronic sorting and make possible the addition of new requirements within the outline. TJC reported that all of the standards and the National Patient Safety Goals (NPSG) will be in sync with the chapter outline. Each standard and NPSG will be assigned a 6-digit number. For example, the 2008 Infection Control (IC) Chapter IC.4.15 will be appear as IC.02.04.01. This number represents:

•02 – the standard is in the implementation section (II)
•04 – the standard pertains to Influenza Vaccinations (D)
•01 – the first standard in the section

The 2009 standards will be reorganized and will include new chapters (example: NPSG) all arranged in alphabetical order by title. Changes to the standards have been made to clarify the language as well as to delete duplicative requirements.

Check The Joint Commission website in July to review the revised 2009 standards for ambulatory, critical access hospital, home care, hospital and office-based surgery programs. To help with the transition to the new numbering system, TJC will provide an extensive, historical crosswalk.

These documents will be on the website until the printed manuals are published in September 2008.

Carole La Pine, MSA, CPMSM, CPCS

La Pine: Vermonter shares experience with CAQH application

Terry Burbo, CPCS, Credentialing Supervisor at Vermont Managed Care, in Burlington, VT and President of Vermont Association Medical Staff Services spoke with me regarding their experience with the State’s mandate to use the CAQH application. Terry stated that approximately 5 years previously, a group had organized to develop a state-wide application. All that work was lost when the mandate for CAQH use was approved.

I asked Terry to share some of the barriers to implementation of the use of the CAQH application. First, it took a long time to implement partly because many hospitals were not aware of this recommendation and felt caught off guard. At first there were many complaints from providers regarding the length of time required to complete the on-line application (estimate 1