Adding new medical procedures or diagnosis technology requires analysis against a health system’s core purpose.
In this blog, Hugh Greeley suggests that medical staff service professionals read, “The Deming Management Method,” by author Mary Walton. Greeley dedicates his focus on Point 1 of the 14 Points included in the book. Point 1 is, “Creating Constancy of Purpose.”
Checklist of things to consider before making a change
Hugh lists nine questions that help align action with purpose. He points out that every new adoption of technology, procedure, or technique comes with the need to examine and adjust things like training, licensure, certification, elements of F and OPPE, and reimbursement, just for starters.
It boils down to a solid understanding of the hospital’s core purpose and mission. Infrastructure is a complex mechanism that takes time and expertise to realign for change.
The following is contributed by Hugh Greeley, author of Hugh’s Credentialing Digest
In 1986, Mary Walton wrote an excellent book titled, “The Deming Management Method.” It has lost no relevance in the decades since its publication. In the book, the author described Deming’s 14 points and the seven deadly sins. It is truly a great read for anyone interested in credentialing, performance improvement, Focused and Ongoing Professional Performance Evaluation (F and OPPE), and general management.
Identify purpose—don’t chase the “new thing” without a purpose
Deming’s Point 1 is of particular relevance to those responsible for credentialing and privileging in the area of new modalities and procedures. Point 1 is simply the need to “create constancy of purpose.” In describing this point, Walton explains that this will require innovation, research, education, and continuous improvement of product and service.
More specifically, the book suggests that organizations should not introduce new technology simply because it is new or flashy. The introduction of new technology (read that “procedures or techniques”) should proceed only after significant research detailing how the introduction will benefit the client (read that “patient”). Deming suggested that such research should include a careful study of evidence that the new innovation results in a better product (read that “outcome”) than the old, that it will not inadvertently introduce quality problems into the production process, that any new training of staff has been considered, and myriad other factors.
Make sure new medical procedures are a fit for the organization
Often this simple suggestion is ignored when a physician requests privileges authorizing performance of a new procedure or technique. In many hospitals, the first reaction to such a request is to ask the physician for evidence of education or training needed to perform the procedure. Credentials committees frequently attempt to determine whether the practitioner is competent to perform the procedure without first asking these simple questions:
- Is this a procedure or technique that the hospital wishes to offer patients and the community (i.e., gastric freezing, cosmetic surgery, deliveries, spinal fusion, etc.)?
- Is there sufficient peer-reviewed clinical research demonstrating that the procedure is effective and not harmful?
- What will be the cost of introduction and the training of nursing and other staff?
- Will the introduction of this procedure unreasonably increase the hospital’s malpractice exposure?
- How will the new technique be marketed?
- How will we conduct a performance review of the new procedure (F or OPPE)?
- What opinion or input do we have from other involved departments, such as radiology, material management, nursing, finance, etc.?
- Will the hospital reasonably expect reimbursement for this procedure (i.e., is the return on investment positive)?
- How will the introduction of this innovation be managed and who will manage it?
Adjust the credentialing process to new medical procedures
Deming recommends that only after such study should an organization contemplate the introduction of a new and potentially beneficial procedure or modality. If the organization does decide to introduce the new procedure, only then must the credentials committee establish the precise criteria to be met prior to granting privileges to any practitioner (all such criteria should include required education, training, relevant recent experience, and evidence of current competence). During this process, it may be necessary to elicit assistance from the potential applicant in gathering information about such things as where this is done at present, what it replaces, what (if any) are the national standards of specialty societies or academies, and what university-based training programs have introduced this procedure.
Walton’s book a must-read for medical staff services professionals
Studying Dr. Deming’s Point 1 should be required for all medical staff services professionals, performance improvement directors, vice presidents of medical affairs, and credentials committee members. After such study, you will find that your organization is far better prepared to deal with the random request from, for example, a pediatric surgeon who desires clinical privileges to perform hip replacements via a hole bored through the ilium or the request of an innovative physician to perform gastric freezing.
|Written by Hugh Greeley
Credentialing and Healthcare Industry Expert
HG Healthcare Consultant