Faculty Appointment, Credentialing and Enrollment

Each year, 300-400 faculty are appointed to the Medical School through the Office of Faculty Affairs, credentialed with the Hospitals and Health Centers through the Office of Clinical Affairs, and enrolled in various contract plans through the Faculty Group Practice Provider Enrollment. Although there have been process improvements within individual units, a cross-organizational viewpoint was required so this MQS project was identified.

Project Scope
A physician once counted that he signed his name 70 times in order to get hired. Departments can wait six months from the time a physician has been identified as a new prospective employee to when he or she can begin seeing patients. Payments for services provided are denied because a physician has not been enrolled in a specific contract. These were all key indicators that the faculty appointment, credentialing, and enrollment process could be improved.

At the August 12, 2005, scoping meeting, various issues were discussed:

• Fragmented process consisting of multiple sub-processes
• Process is inefficient, redundant, paper-intensive, inconsistent and lengthy
• Areas of risk due to variability, (inconsistent letter of intent/ offer letter and background check processes)
• First time quality needs improvement
• Clarity of the process is not well understood
• Importance of process not appreciated
• Linear process rather than parallel
• Deadlines not known/adhered to

These issues led to the development of a project purpose which stated "Improve first time quality and reduce lead time through the development of a standardized process for appointment, credentialing, and enrollment across all faculty tracks." Project objectives were:

• Achieve 100% first time quality for each step of information handoff between sub-processes
• Reduce overall lead time from offer acceptance to physician start date
• Achieve 100% first time quality to complete all privileging and enrollment before start date
• Achieve 100% first time quality of completing a criminal background check before hire
• Reduce number of forms required for physicians to complete to 1
• Eliminate requests for duplicate information
• Reduce number of signatures to minimum required
• Reduce manual work associated with health plan enrollment
• Reduce data entry to one time

The next step in the project scoping was to develop the SIPOC. A long discussion surrounded the definition of the customer. Finally the SIPOC was finalized as detailed below:

Supplier: Candidate/Faculty Member and Department
Input: Personal information and information about desired candidate and position
Process:
1. Department identifies candidate and prepares master packet of information
2. Faculty Appointment sub-process
3. HR/Application sub-process
4. Credentialing/Privileging sub-process
5. Health plan enrollment sub-process
6. Faculty member appointed, credentialed and enrolled
Output: New faculty member appointed, credentialed and enrolled
Customers: Department (primary) and Faculty member (secondary)

The project scope was approved by the leadership panel and the lean workshop was scheduled.

Lean Workshop
The lean workshop for the ACE project was held on September 26, 27, and 28, 2005 and was facilitated by Sheila Hainsworth of General Motors.

Workshop Participants
Allen Lichter (Dean)
James Woolliscroft (Exec Assoc Dean)
William Elger (Exec Director Administration, CFO)
David Spahlinger (Sr. Assoc Dean, Clinical Affairs; Director FGP)
David Gordon (Assoc Dean , Diversity)
Skip Campbell (Assoc Dean, Clinical Affairs)
David Bloom (Assoc Dean, Faculty Affairs)
Karen Dannemiller (MSIS)
Will Jaynes (MSIS)
Ben Ibach (MCIT)
Rob Stauffer (MS Finance)
Deborah Biggs (Deans Office)
Heather Wurster (Clinical Affairs)
Jim Ellis (Credentialing Committee Chair)
Pat Nelson (Medical Staff Services)
Dawn Brennan (CACTUS Enrollment project)
Jan Prokop-Heitman (Medical Staff Services)
Jane Weyher (Faculty Affairs)
Deb Komorowski (FA Admin and Finance)
Kim Leahy (Faculty Affairs)
Mary Wurz (Faculty Affairs)
Benjie Johnson (FGP Provider Enrollment)
Ellen Kayfes (FGP Provider Enrollment)
Adena Kling (MCare)
Vicky Felps (Internal Medicine)
Sue Wheeler (Dermatology)
Katrina Ward Hope (Basic Science)
Michael Warden (Deans Office)
Tammy Ellies (UM Facilitator in training)

For this workshop, the leadership panel was also workshop participants.

Day 1 was spent reviewing the current value stream map and identifying the waste and root cause analysis. During Day 2, a future value stream map was developed. The deliverable from Day 3 was an implementation plan.

The implementation deliverables were separated into committee activities, documents, database, process change, and communication. Specifically these deliverables included:

• EVPMA / Provost Support
• Assistant Professor Committee Review Elimination
• Executive Committee Consent Agenda
• Advisory Committee / Credentials Committee Structure
• Environmental Impact Statement
• Tern Sheet / Offer Letter
• Database
• Show Stoppers
• Faculty V2 Processes
• Co-Location
• Electronic Signatures
• Audit Checks
• Model System with MCare
• Communication Plan
• Education and Training

The ACE workgroup is meeting on a bi-weekly basis with a second process team also meeting every other week. The Leadership Panel will conduct a project review at the following intervals: 45 days, 90 days, 120 days, and 180 days.

For details on this 11 month project, check out the ACE Project website at: http://sitemaker.umich.edu/ace.lean.project