Privileges

1. Privileges Strategies for Deploying and Disseminating Presented by Andrew M. Allemao

2. Keys to Effective and Efficient Privileging • Move from laundry list to Core Privileges • Use technology to decrease the manual process for disseminating privileges

3. Suggestion 1: Migrate to Core Privileges

4. What’s Wrong with Laundry Lists? Wastes physician’s and reviewer’s time • Requires physicians to request every single procedure they may be qualified to perform • The reviewer must evaluate qualification and clinical competence on EACH line item

5. What’s Wrong with Laundry Lists? New procedures and conditions require staff to continually update the list • Privilege lists become obsolete • Writing "other" at the bottom of the privilege request form invites physicians to apply for privileges for which the hospital has no predefined criteria

6. What’s Wrong with Laundry Lists? Potential legal/regulatory exposure: • Many line items have no predefined evaluation criteria • High potential for human error in every step of the process: • Request • Review • Nursing Station/Surgery Scheduling

7. Ask Yourself… “If a physician fails to check a particular procedure on the list and performs that procedure anyway, is your institution liable for a charge of corporate negligence?”

8. “Does your institution critically review each applicant's prior education, training, and experience in every clinical area marked on the applicant's form, even when the request comprises over 60 check marks?” Ask Yourself…

9. Core Privileging The cure for the common privilege process

10. Anatomy of Core Privileges Predefined criteria for each privilege must outline requirements regarding: • Education • Training • Experience

11. Anatomy of Core Privileges Descriptions of privileges and requirements must be: • Accurate • Detailed • Comprehensive • Specific

12. Core Privileges vs. Lists • Less burdensome for the doctor to request • Less time consuming to review • Less prone to Type I JCAHO recommendations • Less likely to have to deny privileges as criteria for holding privileges are well defined

13. Which would you rather maintain? Laundry List Core

14. So Why Don’t More Hospitals Adopt Core? • Defining comprehensive requirements for each privilege category requires a lot of time on the part of department chairs and Credentials Committee members • Laundry lists basically work • General bureaucratic resistance to change

15. Suggestion 2: Use technology to create a less manual process for disseminating privileges

16. Options for Disseminating • Manual Distribution • Electronic Distribution • MSLW installed at all workstations • MSLW or ECHO with Web Portal

17. Manual Dissemination Most Common – Least Efficient

18. Process for Manual Distribution Start Make Copy for Each Nursing Station Update System and File Privileges Approved Collate for Distribution Nursing Station Updates Book Deliver End

19. Manual Distribution - Concerns • Not real time • Pages might not get delivered • Pages might not make it into the book • High human resource cost • High raw materials consumption • Paper • Toner • Binders

20. Electronic Dissemination The cornerstone of electronic distribution of privileges is getting the privileges tied to providers in MSLW/ECHO

21. Options for Getting Privileges into MSLW or Echo • Attach scanned image of the approved privilege form to each provider record • Have privilege templates in MSLW or ECHO and enter the approved responses

22. Process for Scanning Attach Scan Save

23. Requirements for Scanning • Scanner • Hard drive space for the images • Scanned multi-page images must be saved as TIFF images • Client workstations must be able to read TIFF images

24. Pros Conceptually easy Real time Password protected Printable Cons Not searchable Volume necessitates high-end scanner Need software to convert image to TIFF File saving can be complex Scanned Images: Pros and Cons

25. Options for Getting Privileges into MSLW or Echo • Attach scanned image of the approved privilege form to each provider record • Have privilege templates in MSLW or ECHO and enter the approved responses

26. Privilege Items in the Software

27. Pros Query to find who can perform specific procedures Real time Easy to update No special knowledge required to do data entry Cons Up front work to set up privileges time consuming Line Items in the Software: Pros/Cons

28. MSLW on Every Workstation A good way to spread the word

29. Pros Password protected access to privileges Real time No binder update No copying Fewer “weak links” Cons User must learn enough about MSLW to select a physician and view privileges IT support required to install/support MSLW on each workstation MSLW on Every Workstation: Pros/Cons

30. MSLW or ECHO + Intranet The best way to spread the word

31. Intranet Solution for Privileges NU1 NU2 Intranet NU3 Data Server IIS Server NU4 Medical Staff Office Surgery Scheduling OR

32. Steps to Implementing Net Solution • Enter the privileges into the credentialing product • License the MSLNET or ECHO Portal • Prepare web server • Ensure all intended users have web connection • Define who needs to see what information • Design the desired page layouts • Work with HLS to build the template pages

33. Net Solution: Pros and Cons Pros • Real time • Reduced possibility of JCAHO Type I • No need for photocopies • Easier for NU’s • Screens designed by the MSO • Cons • License required • IT required for initial set up

34. Efficiency Comparison - Ongoing MSLW/ECHO + Net Manual MSLW/ECHO Efficiency

35. Hours/Year – Ongoing Dissemination

36. Summary By adopting core privileging and using technology to help disseminate, you can turn a chaotic, error prone process into an efficient and effective one.