Running Out Of Time

And then the floor fell out.

I finally convinced the Director to allow me to take over the files for the new hospital.  Not because I had received training that they knew nothing about, but rather because I insisted on it.  If I am going to be responsible for something, let me be responsible for it – victories and defeats and all.

I took over the new hospital on March 1, 2014, four months after I accepted the position for the new facility.  I won’t sugar coat it – it was hard.  I had to learn how to credential new applicants in a hurry.  I was told, it’s just like doing a reappointment application – it’s not.

I kept wondering why everyone had such confidence in me – I had none in myself.  Here I was, a high-school drop-out (with my GED), with no college education determining if a physician with 10+ years of school was qualified to do his job.  I was reporting to people who had more letters behind their names than I had in my entire name.  I wasn’t even certified to do my job – I had barely started studying to become a CPCS.

It took me much longer to review a file than it took my coworker.  I didn’t have the advantage of 20+ years of experience to determine what was important and what wasn’t like she did.  I didn’t have the knowledge to know how to quickly assemble a file for department chair review.  I was attempting to come up with processes that made sense to transport files 20+ miles away for the new facility and department chairs to review.  The process coworker had started appeared incomplete and not up to Joint Commission standards.

The new facility started questioning if I was qualified to do the work.  They would point out, correctly I might add, that it was taking me 3-4 months to finalize a new application when it had only taking my coworker less than a month, two at most.  I didn’t have an answer for them, just that I was doing my best to ensure that each file was complete and thorough.

I started looking into beginning the reappointments for the new facility.  Coworker stated multiple times that I was jumping the gun on reappointments as it wasn’t necessary yet.  They weren’t due to recredential for another 14-18 months.

I looked at the time-lines – she had credentialed approximately 150 in those first few months and automatically put them on a 24 month reappointment cycle.  There was no way I would be able to recredential that many a year later without missing someone and them going over the 24 month maximum requirement by Joint Commission.  As far as I was concerned, I hadn’t started early enough at looking at the reappointments.

Thankfully, the facilities in our hospital system (18 wholly owned non-profit hospitals) have a sharing agreement across the entities for physician files.  Because of this, I was able to tack on many of my physicians as a “piggy-back” process to the primary facility’s reappointment process.  This allowed me to not have to focus on the entire reappointment file, just the items I needed specifically for my entity.  This allowed me to begin the reppointment process with a number of my practitioners with relative ease each month.

And then our Director was given a choice – retire or be fired.

At least, we weren’t told that, but reading between the lines, that’s what happens when the director of a department for 20+ years is there one day and then gone within less than a week.

I remember the CMO talking to us, but I don’t remember what she said.  I’m pretty sure she was attempting to be encouraging, but I sat there with tears streaming down my face and didn’t hear most of it. I kept attempting to will myself to stop crying, but I couldn’t.  I was at a loss for what I was to do.  The Director who was now gone was who had convinced me that I was perfect for the job.  Now whoever came in next would take one look at me and know I was a fraud.

The CMO asked me what she could do for me since I hadn’t said anything during her meeting with us.  I managed to choke out that I wanted to have a one-on-one meeting with her, she immediately agreed and scheduled the meeting for the next day.

I went home that evening and wrote down all of my questions and concerns.  I showed up to the meeting with the CMO and, based on her facial expressions, I shocked her multiple times.  I first told her that I was not upset for the Director leaving, that I viewed that as a business decision and that it was probably a good step for the department.  I admitted that I felt lost, that I hadn’t had proper training and that I thought multiple issues were going on in the department – that I wasn’t experienced enough to know what, but that the next Director would have their hands full with correcting years of issues.  She was appreciative of the honesty and asked me to give her time to get me the training I needed and the Director I and the department needed.  She just needed time.

Time was something I was fast running out of.

My First Challenge

Chaos.

That is what the department ran on.

Each day opened with some new crisis that had to be averted and solved before doing anything else.  It’s like the ladies thrived on chaos and crisis mode.

Most people who know me know that I do not like chaos.

I seek calm, organization and processes.

Challenge – yes.  Chaos – no.  Medical Staff was both at once.

As different challenges came up, I would ask, “Why is this not already planned for?  Why are we struggling to put out this fire rather than being on ‘fire watch’?”

The responses I received were varied, but similar: “We don’t have time for that” and “It’s not our fault that we’re behind”.  I tried to explain that an ounce of prevention is better than a pound of cure, but little changed.

So, as issues arose, I would make notes about what went well and what went wrong and planned for future responses if it or something similar happened in the future.

One of the reoccurring challenges that seemed to catch them unawares was the committee meetings we were responsible for – Credentials and Medical Executive.  Oh, they knew when the meetings were scheduled each month, but they seldom seemed ready for them to happen.

My first month there, I asked – “Why are we making copies and assembling binders?  Wouldn’t it make more sense to display this information on the overhead or use tablets?”  I was told, “Of course it would, but our attendees want paper.”

That first month, assembling binders for the various committees, was chaotic when it didn’t need to be.  I had experience in preparing for meetings in the past – I have never been so stressed out as I was that first time helping them with meeting prep.  I immediately began making changes.

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Fun Fact – our Physician Liaison told me that before I came to the department, he always wanted to come in on meeting day with a leaf blower to add to the chaos.

 

They waited to make copies until the day of – guaranteeing that the copy machine would break, run out of toner or paper.  Their rational – the documents sometime change, there’s no sense making copies if you just have to recopy them.  True – but when you are putting together 10-20 sections (with page counts anywhere from 1-100), you cannot wait until 2 hours before the meeting to make 20 binders and expect to be done on-time.

As soon as a document was “ready” – I made the required number of copies.  Sometimes that meant I was making copies a week in advance.  Even if I had to recopy the same document 3 times due to changes, I was gaining sanity for myself the day of the meeting.  Now – be reasonable – use common sense people – I did!  If it was only a one page section – piece of cake to copy multiple times.  If it was a 100 page section – I made darn sure it was 99% correct before I made copies.

I verified a month before, the week before and then again the day before that the meeting room and catering menu (as the meetings were held at lunch time) were confirmed.

I made sure the morning/day of the meeting I had nothing else of importance scheduled or planned.  My important task, my one frog, was preparing for the meeting.  That meant that, for me, emails were secondary.  I wasn’t on the phone like my coworker was, calling applicant references begging for that last verification that we were still pending.  Once I started processing files many months later, unless the decree came from the Chief of Staff, Chief Medical Officer or President, if an applicant didn’t have a complete file, they were tabled until the next month.

I planned, anticipated and, to the best of my ability, executed that everything would be ready by a minimum of one hour before the meeting.  This ensured that if something out of the ordinary did happen – broken copier, last-minute document change, roaming mariachi band (that never happened, but if it did to you – that’s awesome!) – I still had time to complete preparing for the meeting without stress.

I could always count on my coworker to tell me exactly how the meeting day would unfold.  She never told me in exact words that the day was shaping up to be calm or stressful – but she showed me in actions.  All I had to do was walk in the main office door and watch her reaction.  If she smiled and said “Good Morning!”, I knew it was a calm day.  If her eyes were huge and said, “Thank goodness you’re here!”, I knew it was a stressful day.

As the months went on, the day of the meetings became less and less stressful on everyone in the office.  Partly, because I knew what to expect and what I was doing, but mostly because I planned in advance how the day would run.  Was it always perfect?  No.  But challenges became minor inconveniences rather than full-blown panics.

What challenges are you battling?  How can you make it less stressful?