As Lisa Rothmuller, CPCS and Dwaina Humphries, CPMSM, CPCS and I reviewed the survey results for the 2020 Annual Report on Medical Staff Credentialing, we compared this years’ results with those of previous surveys (this is the fourth annual report). One of the items where we noted a theme, was the lack of progress made in a number of important initiatives due to “political resistance to change.” As we thought about this political resistance to change (which was no surprise to us – we regularly have the challenge of working with groups where this type of resistance can impede progress), we talked about how to surmount this obstacle and not have a project stalled or completely derailed.
Political resistance to change from internal stakeholders and/or providers is one of the issues frequently identified as a barrier to making positive improvements across the following initiatives:
Political resistance relative to Centralization and Enterprise Standardization was rated highest in this year’s survey results. This should not be surprising to those who have worked in credentialing and privileging for any length of time. Historically, medical staff organizations have been slow to make changes and when the issue involves changes in how credentialing or privileging is defined and carried out. When these changes are proposed in order to standardize with other organizations, that means a loss of control. It has been our experience that medical staff organization leaders are typically invested in their own credentialing processes as well as their own privilege forms and related criteria. They may have spent much time and effort working on them. They understand their own processes and forms. Asking them to change their processes and forms for the greater good of a health system is often not appealing. And – the individuals who support the medical staff organization (medical services professionals – MSPs) and work closely with credentialing and privileging – are often not enamored of standardizing either.
Medical staff leaders can be opposed to standardizing because they don’t want lose control. They often fear that credentialing and privileging standards will be lowered. MSPs on the other hand fear the loss of control as well – and potential loss of employment. For example, if privileges are standardized and managed centrally, rather than by each facility that is part of a health system, the facility MSP is losing part of his/her job. And, furthermore, it may be part of the job that the MSP most enjoys. Often, in these cases, MSPs and medical staff leaders will create boundaries in order to stall or stop a standardization project. For example, they may cite medical staff bylaws provisions that they interpret in a way that would not allow the standardization – even though we all know that bylaws are subject to interpretation (just have two lawyers review the same paragraph and see if they are in agreement of the interpretation).
First of all, the involved MSPs must be supportive of the changes from the beginning. If the MSP is not supportive of a standardization project, he/she can have a huge negative influence on the medical staff leaders. Conversely, supportive MSPs can have a tremendously positive impact on an initiative and can calm doubts of medical staff leaders and others.
Secondly, when a standardization project is proposed to medical staffs, their leaders (the VPs, CMOs, etc.) must be spokespersons for the project and lobby for it. Fortunately, it is becoming more common for standardization projects to come from physicians themselves. They may be completely tired of completing multiple privilege forms within the same health system and ask for one form. Medical staff leaders may understand the implications of having varying privileging criteria within the same health system. So the key with medical staff leaders and physicians is to keep them focused on the benefits of standardization – and put in place a project structure where there is ample opportunity for respected voices to be heard throughout the project.
It should be noted that occasionally, in an honest effort to be collaborative, administrative health system leadership will ask medical staff organizations to weigh in on purely administrative issues. This can be a huge mistake. For example, if the health system is going to centralize support for credentialing for the health system, instead of having each hospital separately perform the credentialing process, that is an administrative decision – not a decision that individual Medical Executive Committees need to be involved in making. Once administrative leadership asks the question – they are stuck with the answers. It is best that administrative leadership make decisions about how to provide support for medical staff organization functions. Standardizing privilege forms across a health system, however, is definitely an endeavor in which each medical staff organization must be involved and one for which support must be obtained by being transparent about the benefits as well as the necessity for cooperation among the involved medical staff organizations.
MSPs – you are in the enviable position of having a lot of influence on the medical staffs with whom you work. I am proud to work with MSPs who use their influence in the best interests of their organizations and the patients that their organization serves.
Our best to all of you as you continue your important work during this national emergency of COVID-19. We are grateful for the work that you do and are proud to partner with you.