Key Policy Recommendations for Collecting Professional References as Part of Your Credentialing Process

Credentialing is critical to patient safety. It’s a complex process that requires many steps including conducting background checks, contacting licensing boards, reviewing license applications, obtaining education information, and collecting references.

In the early 80’s, collecting references for credentialing purposes was a simple task. References were basically letters of recommendation that confirmed a candidate was a “good person.” They didn’t focus on a provider’s specific skills, specialties, or competence.

A lot has changed in the past 40 years. Nowadays, references for credentialing purposes are designed to ask specific questions that allow employers to gain a better understanding of both a candidate’s clinical competency and his or her ability to fit into an organization.

Establishing a solid policy around your reference approach will help you get the information you need to hire competent and qualified candidates. It will also ensure that everyone involved knows what’s expected and when, so that references checks can be completed in a timely manner. Your policy should include:

• A series of standard questions to be used with all candidates
• Details on the number and kind of references (directed or volunteered) required
• A method for requesting, storing, and tracking references
• Details on the type of references accepted (written vs. oral)
• Guidelines on turnaround times

Standard Reference Questions

Having specific questions will help you evaluate candidates in all areas of competency and ensure you can compare candidates side by side. Your questions should ask about a candidate’s:

• Clinical judgment/knowledge of field
• Best fit in terms of practice environment
• Leadership skills and ability to work as part of a team
• Personality traits, reputation, and work ethic
• Oral and written communication skills
• Ability to adapt to new situations and handle stress
• Professional competence
• Malpractice history/judgments against them

Most importantly, you want to know if the reference would accept this candidate on their staff today, and in what capacity.

Number of References

Three references tend to be the industry standard. We recommend asking for three directed references. If the applicant chooses to add others, they can serve as a surplus. Some specialties may require five references. Regardless of the number of references you wind up requiring, the most important thing is to be consistent and request the same of each candidate.

Directed References

Instead of allowing the applicant to choose whomever they want to provide as a reference, it might be helpful to provide direction on whom you would like to hear from. This way you will connect with individuals who have had relevant experience with them.

For example, if it’s a surgeon applying for privileges, you may want to speak to their previous Department of Surgery, the Chief Nursing Officer, and the Head of the Operating Room. These resources are in a better position to identify the applicant's current competency, as opposed to close friends at the organization.

It’s also important to remember that you’re not limited to using only the provided references. You are welcome to write to different organizations the applicant has served under, especially if you feel the references provided aren’t painting a full picture.

Requesting, Storing, and Tracking References

The method in which an organization requests a reference is completely up to them, and can also vary based on scheduling needs. We’ve found, especially with technology becoming more and more sophisticated, that the best way to ensure timeliness is to obtain references electronically.

However, that is not to say that oral references aren’t useful. In fact, many organizations prefer to use oral references as they can be extremely helpful in turning up red flags and collecting more detailed information. Just remember to note that oral references will also be on the record.

Timing

Without a due date, the task inevitably ends up on the back burner, which means the reference check might not be completed. That’s why we recommend specifying a turnaround time when a reference request is made.

You might also elect to make the applicant responsible for ensuring the reference check is completed. In that case, when 10 days pass without a response, you can reach out to the physician with a simple message like: “Dr. Smith, your references haven’t responded yet, could you help put us in touch with them? Their delay is holding up your application.” This little nudge can go a long way in moving the process along.

Bottom line, credentialing professional references is of the utmost importance in guaranteeing your organization is protected and your patients are safe. Things have changed a lot since the casual checks of the 80’s. Having a standardized process in place for collecting references ensures that references are helpful - not headaches!