Privileging Projects Require a Phased Approach: Follow these Fours Steps to Project Success

Medical Staff Professionals (MSPs) all over the nation agree: privileging projects are tricky! They take time and require the utmost attention. The VerityStream team serves over 2,400 hospitals and has been in the trenches with our clients countless times as they roll out privileging initiatives. We’ve seen firsthand that success starts with a phased approach. This post will walk you through the phases we recommend, highlight common challenges, and offer insight into overcoming them.

Phase 1 - Making the Case

Before any work can start on a project, you must first make the case for why the project needs to be done. This is the time for MSPs to present a high-level outline of the project’s vision in order to get buy-in from the powers that be. This document is usually referred to as a Concept Document or Project Charter. Generally speaking, the Concept Document showcases the purpose of the privileging project, why the project is being initiated, what the desired outcome of the project is, and a general overview of how it will be approached in five steps or less. You’ll also want to include information on who is authorizing the project.

Every project will have differences in their approach, but a typical Concept Document for a privileging project will usually look something like this:

On the left we see the Concept Document’s general outline, and on the right we see a more detailed breakdown of how the project will unfold along with expectations. This is also when any special rules pertaining to the project would be mentioned, like not requiring consensus to move onto the next phase of the project.

What is the main obstacle in this phase? As you have probably already guessed - it’s time. Privileging projects always tend to take longer than one would like, but worry not! We have a few tips that can help keep you on track.

• Gain approval based on the entire project as opposed to every individual aspect of the project.
• Use software to save time and allow for accurate reporting.
• Send out frequent reminders and updates of where the project stands to help move the project along.
• Inform physicians that the project is a priority that must be completed as soon as possible.
• Try to use as few specialty representatives as possible.
• Schedule multiple meetings with different specialties ahead of time - it’s much easier to cancel if you no longer need a meeting than it is to schedule an additional one last minute.
• Move from approval to the “comments period” with a firm deadline.
• Invest in dedicated project support.
• Enforce project rules!

Phase 2 - Project Planning

Oftentimes, the temptation is to move into DOING as soon as a project is approved, but when it comes to privileging, creating a comprehensive plan before any work is started is critical. As we’ve discussed, these projects are large undertakings that require a lot of due diligence, which is why detailed planning is essential. Though planning will differ depending for each organization, some best practices apply to all:

• Set definite criteria, they must be clear and implemented facility-wide to avoid any confusion or error.
• Allot as much time as possible for the project giving yourself a buffer, so you’re not at risk of coming up against a deadline.
• Set up a privileging task force, with a dedicated project manager.

A privileging task force is key in helping your privileging project succeed, as is provides a mechanism for:

• Legitimacy and transparency
• Unity: provides a unified structural mechanism for one recommendation to be forwarded to multiple medical staff representatives
• Consistent project support
• Bandwidth to service the project without other “agendas” interfering

With a privileging task force, you have a group that is focused on the project alone. They take on making sure cross-privileging is taken into consideration, listen to all recommendations to create one cohesive document to present to the Medical Executive Committee (MEC), assist Project Managers with any problems as they arise, and much more. We recommend making the privileging task force as small as possible; it's much easier to gather a small group for a meeting than it is a group of 20.

In our experience, organizations with a privileging task force who don’t also assign a dedicated Project Manager tend to fall short. With a dedicated Project Manager, you have an individual whose primary function is the project, as opposed to something they take on in addition to their core responsibilities. Though not essential, we also recommend selecting a Project Manager with a clinical background, as they will have inside knowledge that will go a long way in saving you time, resources, and sanity.

A large part of planning is inventorying the specialties practice your organization engages in. You want to identify what specialties you currently privilege as well as how privileging decisions are made. You’ll also want to determine if there are any “holes” in coverage with regard to specialties and locations. As part of the inventory process, you want to confirm with operations management that your organization has privileges that cover all services provided. We recommend creating a Form Status Grid that depicts your future inventory.

Phase 3 - Review and Finalize Delineations

With project approval and a plan in place, you’re now ready to finalize delineations with specialty representatives. This part can prove cumbersome. Sometimes, participants are resistant to the new process, and will refuse to implement the system you outlined. The most surprising part is that you never really know what specialty will be problematic or controversial, so it’s close to impossible to prepare. You may even come across serious disagreements within a specialty that you’ll need to contend with, all while keeping within your timeline. Again, it’s a lot to tackle, but we’ve got tips for you!

• It’s difficult to choose what specialty representative to work with, but do not be discouraged. Consult with your medical staff for guidance, and choose someone who will actually be of assistance, not just someone who holds a title.
• Build expertise and experience by starting with the less controversial specialties.
• Forget the old privileges, focus on what is being built and the new parameters you’ve put in place.
• Follow the rules for decision-making outlined in the project charter.
• Keep the project moving forward - this means checking in frequently, sending reminders, keeping your team accountable, etc.
• Have standardized best practice forms already created/updated for use.
• Have a draft of the delineations created so that you can receive detailed and constructive feedback on the new plan, as opposed to showing up with the old process and asking, “What can we change?"
• Once you have decided on a physician representative, host an educational meeting to ensure everybody involved is on the same page with regard to project expectations.

PHASE 4 - Transition to New Delineations

After all of this, you’ve arrived at the final phase, one that is equally as complicated as the others and is just as important. As you transition to new delineations, you must be certain that existing privilege holders do not lose those privileges as a result of the transition. You will also need to ensure that there aren’t any outdated privileges clogging up the process. The best way to navigate this process is by using Conversion or Privilege Mapping.

Privilege Mapping is the practice of taking existing privileges and correlating where they apply within the new delineation. You are administratively identifying what privileges practitioners continue to hold within the new form.

Privilege Mapping requires a lot of up front time and work, but we find it especially worthwhile in ensuring project success. We recommend mapping privileges in this style early in the process as it will provide you with an additional mechanism for quality control. 

How does Privileging Mapping work?

1. Create a list of existing privileges on the left column.
2. The Project Manager will then draft the likely mapping scenario of new privileges in the right column.
3. Once complete, review suggested mapping delineations with a trusted clinical source, like a department chair.
4. After that, submit the Privilege Mapping document to other department chairs to get their approval before submitting it to the task force.
5. Allow the task force to resolve any issues that may arise.

Privilege Mapping is useful for a variety of reasons. First of all, it can ensure all team members are using the same nomenclature, which will help reduce redundancies and confusion. It also helps identify procedures that had not been previously mapped (providers who had previously done those procedures will then have to apply as new applicants within the new form). Conversion or Privilege Mapping is one of three ways you can transition new privileges to existing holders. If this method doesn’t work for you, you can consider:

1. Getting providers to request privileges in the new form. If this method is used, providers can only ask for privileges they have had in the past. This requires extensive behind-the-scenes audits. While it’s doable, it’s not a process we recommend.
2. Keeping current providers under the old form until they reapply. When they reapply, they can do so using the new form. For all new practitioners, use the new form. This is doable, but it means you will have a long overlap period where you’ll be in two privilege settings. Again, this option is not ideal but it is possible. 

Final Thoughts

One thing's for certain, you want to make sure you have a plan for rolling out new privileges so that everybody involved knows what to expect. This could mean having a single point person to answer any questions, or a group of thought leaders who can serve as beacons of information. We find it helpful to create different materials, like FAQs, as they will go a long way in streamlining the process while keeping everyone on the same page.

Remember, you’re never done with privileging. That’s why it’s imperative that you develop rules for the application of new criteria so you can keep your privilege forms maintained and updated. If you’re using software like CredentialStream, you’ll receive monthly updates that will enable you to identify changes you need to make to your process. As we said at the start, privileging projects are tricky, but know that you are not alone! Helping organizations with their privileging projects is our bread and butter— we’re here for you. No matter where you are in the process, we can help. Give us a shout, and let us help you with the entire provider lifecycle.