As we observe Patient Safety Awareness Week at PreCheck, I thought I would discuss the important role that an effective background screening process plays in patient care and safety. During this time, background checks may be overlooked as a patient safety initiative, but they play a key role in safeguarding both patients and healthcare organizations from harm. In a 2010 article for The Hospitalist, Tim Lary, Vice President of Physician Staffing at IPC: The Hospitalist Company, states: “Any competent healthcare organization will conduct a background check on hospitalist job candidates, first and foremost to ensure patient safety and a safe practice environment for other healthcare providers.”

Although there’s no law requiring hospitals to run background checks on employees, most employers choose to do so. Background checks demonstrate that a healthcare organization has done its due diligence in assessing the safety and competence of candidates.

I mean, you wouldn’t want to hire a doctor like Tara Knowles from Sons of Anarchy (SOA), would you? Every Tuesday for six seasons we rooted for Tara and her righteous ways. While she was busy trying to lead Jax and her sons away from the club, did anyone notice the crimes she was committing? She is the epitome of a good girl gone bad. The good doctor didn't commit any of these crimes until after she was hired at St. Thomas Hospital. In a span of six seasons, Tara was an accomplice to a few murders, stole medical supplies and drugs, physically assaulted her administrator, risked hospital security by helping her fugitive mother-in-law flee the country and also committed insurance fraud. Obviously, St. Thomas Hospital in Charming, California was not performing rechecks!

While Tara Knowles and the hospital she worked at are fictional, the reality is, situations similar to these happen every day and not just with doctors. We can't stress enough the importance of background checks at the point of hire as well on an ongoing basis because you never know what happens as time passes. Therefore, here are a few key areas where background checks play an important role in ensuring patient safety and what to look for when reviewing your background screening policy.

At Time of Hire: Pre-Employment Screening

According to the 2014 Compliance and Ethics Program Environment Survey, nearly all organizations (93 percent) conduct background checks for some or all individuals in positions of trust. As mentioned above, most employers choose to conduct background checks at time of hire even though the law may not require it because they can help mitigate risk. Not all background checks, however, are created equal. It’s important to review your background screening policy with legal counsel to ensure that you are running the right types of background checks. As a healthcare organization, there are certain components, such as an OIG exclusion check, that should be part of a pre-employment background check. Be aware that database searches, including the FBI fingerprint-based search, are considered highly inaccurate in the employment screening industry. In order to check against the latest publicly available information, it’s important to check the primary source, such as local state and county-level records.

At Time of Appointment: Don’t Forget to Screen Medical and Allied Health Staff

Background checks shouldn’t be exclusive to human resources in hospitals, especially considering the emerging industry trend in physician employment. Criminal background checks should be a part of the medical staff credentialing process, too. In a recent interview for the PreCheck Blog, Jesse Adam Markos of Wachler & Associates, states, “Criminal background checks fill in any potential gaps in credentialing search efforts and help to assure that those gaps do not present quality of care or safety concerns for the organization and its patients.” Healthcare HR and medical staff services departments should review background screening policies together to ensure they are applied consistently throughout the organization.

On an Annual or Biannual Basis: Criminal Rechecks are Key

Of the organizations that reported utilizing background checks in the 2014 Compliance and Ethics Program Environment Survey, only 16 percent performed them periodically. Even if you have already done the pre-employment background checks on current employees, it’s important to monitor everyone on staff on an ongoing basis. Some state regulations require that certain healthcare organizations conduct ongoing background checks on staff, but it’s an industry best practice even if your organization is not required to do so. For medical staff services departments, it’s highly recommended to conduct criminal background “rechecks” at time of reappointment or any time there are any changes in privileges. A background check is a snapshot in time, so you may find something new in someone’s background check that wasn’t there in the pre-employment background check, especially if it’s been several years since a current employee’s hire date. Not running criminal rechecks can be risky; you may find your organization with a few individuals like Dr. Knowles who committed crimes after their initial date of hire or appointment, whichever the case may be. 

Monthly Monitoring: OIG and State Medicaid Exclusion Screening

According to the Office of Inspector General (OIG), there are over 66,000 healthcare providers that are currently excluded from all healthcare programs. While checking the OIG’s List of Excluded Individual’s and Entities (LEIE) should be part of a pre-employment background check, a 2013 OIG Special Advisory Bulletin reminds healthcare organizations that the exclusion list is updated every month, making monthly monitoring the new standard in the healthcare industry. Additionally, there are 34 public State Medicaid Exclusion Lists that exist; many which do not report to the OIG LEIE on a timely basis, or at all. An effective exclusion screening program will include a monthly check of the OIG LEIE as well as any of the publicly available State Medicaid Exclusion Lists. This will ensure that healthcare organizations are screening against the latest publically available information in a timely manner. 

Does your organization’s background check policy cover these key areas? Contact us today to learn how PreCheck can help you streamline your background screening processes to support your patient safety initiatives.