Improve screening techniques for sexual boundary violations

While most credentialing teams conduct background checks, certain areas remain weak when screening for sexual boundary violations. To improve their techniques, hospitals should take several key steps.

Expanding reference checks: One of the biggest gaps in how credentialing teams screen for misconduct lies in how they handle reference checks. Traditionally, hospitals request peer references from colleagues who have worked closely with a provider, but this approach often misses nonclinical complaints. In fact, nonclinical supervisors are the ones who may have received complaints about misconduct. Thus, Todd Sagin, MD, JD, a national expert in medical staff governance and credentialing, advises credentialing teams to expand their reference networks.

"Include personnel departments, risk managers, and nursing or administrative supervisors," he says. "These individuals may be more likely than traditional medical staff leaders to receive complaints of sexual boundary violations. You might or might not get responses from those people, but making the query is a reasonable part of due diligence."

Asking the right questions: "Rather than just a broad statement—‘Have there been any conduct concerns?’—it may be useful to be very explicit: ‘Have there been any allegations of sexual boundary violations?’ " Sagin says.

Some institutions will hesitate to provide detailed reference information due to liability concerns. However, not giving up is again part of the hospital’s due diligence. Follow up on any vague or noncommittal references with additional queries.

Additionally, hospitals should require applicants to self-disclose whether they have ever been subject to disciplinary actions, chaperoning restrictions, or complaints regarding boundary violations. If an applicant refuses to disclose, that alone should be considered a red flag warranting closer scrutiny, according to Sagin.

Broadening checks of other relevant sources: Not all disciplinary actions or complaints appear in routine license verifications. Sagin advises credentialing teams to request open records from all state medical boards where the practitioner has been licensed.

"State medical boards sometimes carry out more comprehensive investigations than other entities," he says. Even if a board ultimately did not take disciplinary action, records of an investigation can signal concerns that warrant additional scrutiny.

In addition, social media and online complaints can sometimes reveal patterns of allegations that might not surface through traditional credentialing sources. Internet searches should be a routine part of screening.

Editor’s note: This article was excerpted from our Medical Staff Briefing newsletter.