Strengthen information gathering from references

One of the key challenges that low- and no-volume providers present is how to assess their competence when you have little or no data on their performance in your organization. Most medical staff leaders say it is difficult to get any information of real value from references today. Yet for low- and no-volume providers, we often don’t have any other choice but to depend on references for information about provider competence.

It’s important to strengthen your process for obtaining the most useful and accurate information you can from references. This begins with redesigning your reference form. Be sure to include all the Accreditation Council for Graduate Medical Education general competency areas on the reference form; however, these are just categories. It is therefore important to translate each category into questions about specific performance and behavioral attributes that help you differentiate one provider’s performance from another.

Next, be sure to train your credentialing staff and medical staff leaders in how to spot red flags in references. Red flags can be a rating of anything other than excellent on specific attributes, such as “consistently acts in a professional manner” or “consistently complies with medical staff and hospital policies.” A red flag can be a question left unanswered, or it can be a hint in the form of “please feel free to call me if additional information about this applicant is required.” Such a statement from the reference contact is almost a plea to be called so he or she can tell you “the rest of the story” that isn’t in writing.

Individuals and institutions providing references may still be afraid of providing honest feedback for fear of retaliation. A tool for addressing such situations is a special release form signed by the applicant. Such a release includes tighter language than the typical release and prohibits the applicant from suing the reference contact. If the applicant refuses to sign such a special release and the needed reference cannot be obtained, the application remains incomplete and cannot be acted upon. This approach places the burden on the applicant to ensure that you have enough information to make an informed decision about his or her request for membership and privileges.

Finally, it’s important to engage your physicians in calling references personally. Far more information is gained in a physician-to-physician telephone call than in a written reference or a call by a medical staff professional. To get the most out of calling references, train your section chiefs and department chairs in a disciplined approach on how to conduct the call and document the discussion.