Credentialing: An Important Component of Patient Safety and Practice Quality

In the fall, Dr. Tom Sparks* hired a new dental hygienist. He was sorry to have lost Melissa, the previous RDH, whose family has moved to another state. But he was thrilled when Suzanne applied for the job. Her resume revealed a highly-qualified and experienced professional. Recently divorced, Suzanne had relocated from another state to be closer to relatives.

In reviewing her resume, Dr. Sparks

noted that Suzanne had a bachelor’s degree in education as well as an MBA. He was excited about the possibility of having a staff member with the potential to support patient education as well as business processes. Afraid that another dental practice might

make her an offer, Dr. Sparks promptly hired Suzanne.

He began to plan improvements that would benefit from Suzanne’s training. First, he’d ask her to assume some administrative duties, possibly developing educational programs for patients and ordering office supplies. If things worked out, he would promote her to office manager, thus relieving himself of some of the reports and business-related tasks that cut into his time with patients. “Who knows,” he thought, “I may eventually hire another hygienist to free up more of Suzanne’s time for administrative responsibilities.”

Dr. Sparks assumed that Suzanne would be an asset to the practice. The

*All names have been changed.

An Important Component of Patient Safety and Practice Quality

patients seemed to make a comfortable transition from Melissa’s care to Suzanne’s. Lindsay, the receptionist and Della, his assistant, also welcomed Suzanne and made an effort to make her feel at home.

The following April, on a day when the waiting room was full of patients, uniformed marshals appeared without notice. They flashed badges at Lindsay and

demanded to see Suzanne. Dr. Sparks, who was with a patient at the time, was forced to abandon the patient’s treatment to see to the disturbance. Marshalls arrested and handcuffed Suzanne in front of the doctor and his staff and led her out through the waiting room past the astonished patients.

However, as Dr. Sparks began to assign additional tasks to Suzanne, both Lindsay and Della voiced concerns about some of the changes. “Maybe they’re a bit jealous,” Dr. Sparks told himself when Lindsay reported that Suzanne had brought in a drug rep to discuss the possibility of dispensing pain medications in the office. Suzanne had explained to Lindsay that patients could go directly home following a procedure without having to first stop at a pharmacy to full a prescription. Neither of his senior employees was in favor of this new plan. “Well, let’s just give it a try and see if it works,” he told Lindsay. Consequently, Lindsay and Della no longer expressed their concerns to Dr. Sparks.

According to the arrest report, Suzanne had been trafficking in drugs, selling small quantities of unlogged drug samples, mostly painkillers. She had also been selling prescriptions that she’d filched from Dr. Sparks’ prescription pads. An alert pharmacist had noticed a discrepancy in the dentist’s signature and reported his concerns.

Dr. Sparks’ practice was closed for nearly a week as federal investigators went through his books and checked his records. For a time, suspicion also centered on the dentist and his other staff members. Ultimately, they were cleared of any wrongdoing, but the stress and hassle factor took a toll on the team’s morale.

It was true that Suzanne was a dental hygienist and held a master’s degree, but her job application skipped several other important facts. Having lost her license in another state, Suzanne had gone back to school to complete the master’s degree. During that time she had also sought drug counseling, ultimately receiving a lenient judgment from the court because of her apparent commitment to rehabilitation. Her relocation was motivated,

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at least in part, by a desire to elude her tarnished record.

Because Dr. Sparks was forced to participate in lengthy interviews as part of the ongoing investigation, he lost many hours that he could have spent treating patients. The arrest and resultant press attention to Suzanne’s drug scam garnered unfavorable press for the Sparks clinic. Several patients transferred to other doctors’ practices and Lindsay soon resigned—partly because she resented being involved in a criminal investigation, but also because she was upset that Dr. Sparks hadn’t listened to her when she’d tried to voice her concerns about Suzanne’s actions.

For Dr. Sparks, the hiring of Suzanne Breeze was a painful experience. The state dental board summoned him to appear before a peer review panel and ultimately issued a disciplinary statement which was reported to the National Practitioner Data Bank. Dr. Sparks’ practice received negative attention in the local press. He’d lost several patients, some of them of long standing. And a valuable employee had resigned.

In fact, Dr. Sparks was lucky. Other healthcare professionals have not been so leniently treated by federal investiga-

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tors. In addition, it is fairly common for negative media attention to generate professional liability claims or complaints to regulatory agencies, i.e., departments of health, OSHA, state licensing bureaus, etc.

tice to employment-related liability. Don’t hire a “warm body.” If you can’t find an acceptable candidate among the first round of resumes and interviews, reopen your search. It’s better to wait until the right person comes along than to make a mistake it may be very difficult to correct. 3. Always use a job application and

Dr. Sparks learned his lesson, he says. Following are suggestions he’s used to ensure that the next “good egg” he hires, really isn’t a “bad apple.” 1. Whenever possible, interview more

than one person. Even if you end up hiring the first person you interviewed, wait until you’ve interviewed all the candidates before making up your mind. In that way, you’ll be more inclined to give each candidate a chance to reveal his or her skills and talents. No two candidates will be the same; the flashy, charming candidate should not be allowed to override the quiet, and perhaps more substantive candidate. 2. Hire the individual to fit the job description; don’t stretch the job description to fit the individual. Making special accommodations, especially when they don’t make sense from a job design perspective, may create an undue burden for other employees. It gives the impression of favoritism and could expose the pracalways require a resume. Using two documents may identify discrepancies in the candidate’s history. A job application will also ask for information that may be unlikely to be included in the resume: a) have you ever been arrested; b) may we contact your previous employer, etc. Be sure that the application doesn’t request information that is precluded by law. An attorney who specializes in employment law can be helpful in developing hiring policies and procedures. For example, an attorney will advise how best to include in the application process a statement that will require each potential employee to assert that he or she is telling the truth by completing the application — and acknowledging that the practice has the right to terminate the candidacy/ employment of any individual who lies in the application process. 4. Always check references. In general,

it’s best to ask for work-related or school-related references. The assessments of friends or relatives are unlikely to be as revelatory as those provided by fellow workers. Ask questions like, “If you owned a small business, would you hire X?” “Why/why not?” When a potential employee holds a license, be sure to inquire about that person’s status from the state licensing board. Is the candidate’s license current? Are there any disciplinary actions? In Dr. Spark’s case, he should have contacted the state from which Suzanne obtained her RDH license and where she had ostensibly practiced before her move. Ensure that all employees’ licenses/certificates are

updated annually — and retain copies of those documents in employees’ confidential human resources files. Potential employees who hold licenses should also be asked to provide proof that their Continuing Education obligations have been met. 5. Contact previous employers. Some organizations may invoke a policy in which they will specify whether or not an individual was employed but are unwilling to discuss the details of the employment and/or termination/resignation. If you can’t get them to give you much else, see if you can get them to answer this one question, “Would you rehire this person?” 6. Document all actions taken to address questions that may have been raised during the course of an interview. Ask to see copies of previous employee evaluations. Candidates who are proud of their previous work records are often able

GEORGIA, LOUISIANA & TENNESSEE Earl Douglas, DDS, MBA, BVAL (770) 664-1982 earl@adssouth.com

to produce copies of these evaluations. 7. Once you’ve successfully negotiated the hiring process for a new candidate, always send a follow-up letter to the other candidates. Thank them for their interest, wish them well with their careers, and tell them that, although their qualifications were impressive, you have selected the candidate who you think most closely matches the practice’s current needs. 8. Retain copies of all documentation related to employment issues. Just a few of these items are: licenses, degrees, certificates, resumes, applications, references, and any other correspondence related to the hiring, training, discipline, promotion, or discharge of an employee. Ensure that the new employee is given a copy of his or her job description and that a copy of the document is also retained

in the individual’s confidential personnel file. The American Dental Association offers some excellent

materials to help dentists ensure that their human resources processes are organized, complete, and legal. The tips listed above are more closely related to employment law than they are to professional liability. However, poor hiring choices are often related to improper credentialing of potential employees. The unscreened employee may have a negative effect on a practice’s efficiency, morale, or the legality of its operations. By recruiting and retaining ethical and motivated employees, doctors can reduce the risk of patient

injury and/or dissatisfaction — both of which are key components in healthcare malpractice litigation. ■

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ALABAMA, MISSISSIPPI & W. TENNESSEE Rebecca Kyatt (205) 253-9094 rebecca@adssouth.com

N. CAROLINA, S.CAROLINA & VIRGINIA James J. Howard, DMD (910) 523-1430 jim@adssouth.com