Can It Get Any Harder?

About eight months into my employment with the Medical Staff Office, we were hit with another HUGE challenge.

Even though my coworker and my Director both complained that our office was understaffed (which I agreed with whole-heartedly), the Director maneuvered our facility into the position to accept the challenge of credentialing providers for a brand new entity that our company opened up.  That meant we would be responsible for our providers, plus another hospital’s providers.

I will never forget how round my coworker’s eyes became when our Director relayed the information to us.  We were told at the end of June, the facility would be opening up mid-September – we would have less than three months to completely credential enough new applicants/providers to fully staff a fully functioning new hospital.  Did I mention at the time we did not have any Bylaws, no privilege forms, and Databank was not set up (or any other systems set up for that matter) for this new facilty?

When we went back to our desks, my coworker grabbed a pile of reappointment files off her desk, walked to mine, dropped them with some force onto my desk and stated, “These are now yours.  I won’t have time to do them anymore with the new hospital.”


I sputtered, “But I don’t know what I’m doing with these!”

Her, “Nonsense.  You were working the files just fine when I was gone on leave of absence.  Just keep doing what you were doing.”

Me protesting to both the coworker and Director was met with denial that I needed more training, assurance that I was doing just fine, and the expectation from both that I would take over and complete the reappointments for that month and going forward.

I learned the hard way that I needed to ask more questions.

I didn’t ask for case lists – let alone know how to read them and interpret that there were enough cases for specific privileges.

I struggled with communicating with the doctors and their credentialing staff.  I approached them like I had in my other positions – a weak email request with a “if you wouldn’t mind” tone rather than firm statements with hard deadlines.  I didn’t know that I would need to babysit and follow up with them, sometimes multiple times, just to get them to follow through on simple requests.

I could check the items off my database checklist just fine, but I had no idea if files were considered complete or not.  I had no one suggesting that my files be audited or that I audit myself.  I had no idea what an audit was!

I learned, years after the fact, that I wasn’t even taught how to review an application to determine if it was “complete” or not.

I cobbled together most of my working credentialing knowledge from trial and error, being repremanded that I missed something major, or from overhearing something someone else was talking about at a meeting or conference.

In between learning how to credential a reappointment file, I was also learning about Stark Laws, EMTALA and ER call schedules, planning and booking multiple attendees to out-of-state Horty-Springer conferences, leadership contracts and dealing with a “hostile-take-over” of a department chair position (that was fun).

The only thing that could have made that first 9 months worse was to throw in there a lawsuit and Fair Hearing.  Thankfully, that didn’t happen, but I did learn something about it as we were contacted by the State Medical Board regarding one of our physicians being investigated.

Nevermind the fact that I also attempted to have a life outside of work.

I relay all of this information to assure you, the reader, that you aren’t the only one struggling with this job.  It’s the new millenium for crying out loud!  Why are we struggling to learn these things?

Maybe it’s because, like me, I had people who didn’t know how to train.  Maybe it’s because you have an entity or leadership that is still stuck on doing things the old ways.  Maybe it’s because you, like me, don’t know any better and just doing what you can to get through another day.

What horror stories do you have from your first year?


Learn The Database

My next challenge was to learn the database that we used to store all of our provider information on.

There are several different software systems out there:

  • Cactus
  • Echo
  • MD-Staff
  • Morrisey/MSOW
  • And probably a whole bunch more that I’m not aware of

My particular company uses MSOW, but I have heard from others that Cactus and Echo are similar systems, with similar features.  I’m willing to guess that the other programs that I’m not familiar with are the same with similar systems and similar features.  The point of this post is not to highlight a specific database or to tout one as being superior to the others, but rather to speak on challenges that we all may face.

So what were my challenges in learning my credentialing database?

To begin with, remember me relating that my coworker and Director were not good trainers?  This carried over into the database realm.  I was instructed on how to log-in, how to look up a provider and which button to click on how to save “this particular document”.  Every few days, I would get another instruction on a different document and what to do with it.

The database was huge!  It had at least 2 dozen buttons, all doing different functions.  And heaven forbid you click a wrong button; you either lost yourself down a rabbit hole maze with no way out except to log-out or received a screen that might as well have said, “You’re not authorized to be here – GET OUT!”.


It was intimidating to say the least.

As I have self-taught myself many computer programs over the years, I undertook the task to learn the credentialing database.  To be honest, it took me months to learn enough for me to feel comfortable enough with the program to actually explore on my own (as I was also having to learn my actual job duties – it left less and less time to “learn” a computer program beyond immediate day-to-day needs).

Growing up with computers, I have learned that MOST programs will not allow you to delete anything without double-checking that you really really really mean to delete it.  So I would explore by randomly clicking on buttons that I had no idea what they were used for or what they did.  If it asked me to “save” or “delete”, I usually said no – especially if I didn’t know what I was attempting to save or delete!  This is how I formed the majority of my working knowledge and “expertise” in my database.

Even after 6 months of being in the program, it wasn’t uncommon for me to exclaim out of the blue to my coworker, “Hey!  Did you know ‘this’ button does ‘that’?”

I usually received a response back of, “Yes, I just don’t use it.”  Well….that explained why I didn’t know about the feature before that moment, but since I considered it an awesome feature that needed to be used I would question ‘why not’?  I would get a range of answers of ‘I just never use it’, to ‘it doesn’t work properly’, to ‘why would we use it?’.

Case in point – MSOW has a Gap Analysis feature that isn’t very obvious.  The screen it is on uses the “print” icon.  I had overlooked it for months because I didn’t need to print that particular screen.  One day, I was really struggling to figure out if there was a gap in one provider’s education/work history, so I decided to print out the various screens of information so I could use a ruler and pencil system.  Imagine my surprise when the program calculated the information for me with just a couple of clicks of the button!  I think I mildly struggled with this task for almost a year before I stumbled upon this feature.

What my coworker and Director did not tell me, that I learned on my own, that I would like to share with you now is this:

  • There is online help for your program.  Google it.  I guarantee someone knows how to do what you are struggling with if the immediate people in your office are clueless.
  • If you have the desire – dedicate yourself to learning as much as you can about your database.  I am confident that the database developer has already programmed systems to help you do your job more efficiently.  Use the database to your benefit.
  • If you have the ability within your organization – have at least one employee within your department become a certified ‘super-user’.  This will allow you access and knowledge to utilize much more than just the surface-level of your database.

What did you find challenging about learning your credentialing database?