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The Dynamics of a Checklist – Why Important?

Are you aware of the importance of a checklist? In the medical services profession, a checklist is our guide for keeping track of the files for which we are responsible for credentialing. I am not talking about just checking off boxes or a credentialing to-do list. Keeping track of utilizing the checklist is essential because we need documentation that we have performed the vital requirements for credentialing. Why is that important?


Recently, I read a book called The Checklist Manifesto: How to Get Things Right by Atul Gawande, a world-renowned surgeon who works closely with the World Health Organization (WHO). Gawande pointed out in this book the importance of a Do-Confirm checklist instead of a Read-Do, which is why the credentialing checklist is so important. Our checklists shouldn't be a checklist of what to do to complete a file, but documentation of those vital requirements that include the source of documentation, the date when the information was collected and verified, and most importantly, an attestation that someone reviewed the information, that crucial information. Why is that important?


Here is a quote from the book that hit home since its goal was to promote checklists in the operating room to protect patients. If you read the book, this will hit home for you, too. Just think of the word 'credentialing' instead of 'medicine.'


"Medicine has become the art of managing extreme complexity—and a test of whether such complexity can, in fact, be humanly mastered."


A strong argument for the effective checklist.

Some of us use spreadsheets, others use .pdf or Word documents with checkboxes and scribbles, but the most technically advanced utilizes a database tool, whether it's called a workflow or a checklist. Our common goal is to capture the vital requirements and the complex data to prove we have completed the file and that we have actually looked at the data and assessed the verifications or documents before moving the file to the next level. We have to determine if we have appropriate information for the decision-making level of the credentialing process. I don't know for sure, but I wouldn't be surprised if NCQA created their credentialing system controls standards because of falsely completed checklists due to back-dated or change-dated materials in files. In essence, the documentation and files didn't match what was presented. Why is accuracy so important?


Your first thought is that credentialing is not that complex. It doesn't take a rocket scientist or a world-renowned surgeon to do the job. All that is required is an intelligent person with OCD, yep, OCD. Most successful medical services professionals are obsessive, Type A personalities who won't leave a stone unturned during credentialing. So why would I compare credentialing with the complexities of documenting treatments and surgeries, especially in the operating room? Dr. Gawande's goal was to incorporate a standardized checklist in operating rooms worldwide, and with good reason, for patient protection and to ensure everyone in the room was on the same page. Sounds simple.


A credentialing checklist sounds simple enough, too. Yet, what's being documented is more complex. Think of it this way: a missed timeframe, an unreviewed document such as a report from OIG or NPDB, a claims history dismissed because it didn't meet a timeframe or the timeframe was misreported, or maybe the license was about to expire, any item that could let a practitioner through to your staff and it shouldn't have because the proper protection of the patient didn't take place on the front end. The end that everyone thought was a simple process could become complex litigation or even a criminal mess. So, whatever you do, pay attention to the importance of the checklist. If you need a detailed reminder, read The Checklist Manifesto.

Dilsa S. Bailey, CPMSM is the owner and principal consultant for The Right Credentials Network and an independent publisher and author. If your organization's credentialing and provider enrollment programs need assistance, contact The Right Credentials Network. We can help you apply for and maintain accreditation, build your delegation arrangements and repair your existing credentialing program. And, if you or your staff needs additional training, let us create a package to fit your needs.


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