Alignment of Recruitment, Credentialing and

Improving Provider Retention

Onboarding

The Current Onboarding System is Broken

Recent reports by the American Medical Association (AMA) have indicated the physician hiring frenzy
by hospitals in 2015, has stabilized and the focus has readjusted to better alignment and integration of
providers into the organization (Daly, 2017). Part of this refocus is improving synergy between
hospital departments during the recruitment and onboarding process, which in turn improves
retention of providers who are better aligned with the organization. With an expected loss of
approximately $150,000 to $250,000 per year in the first three years of hiring a physician (Echo
Solutions, 2016), hospitals are trying to reduce the financial hemorrhaging but are facing resistance
from within as departments are unable to see the bigger picture
and are trying to hold onto “business as usual” practices due to
fears of job loss, autonomy and change. Communication between
Siloed
siloed departments has been identified as a significant barrier to Departments

change.

Retention
New providers to an organization go through the recruitment
phase to only find frustration during the onboarding phase. Siloed
Provider
departments are usually unaware of a new provider joining the
organization until a few days before hire and are asked to do an
impossible feat of credentialing a new provider - both hospital and
health plan credentialing – in a short timeframe, as well as process the provider through the myriad of
steps in the Human Resources process. This lack of communication creates disharmony and
resentment between the departments. In addition, the provider becomes frustrated due to the
duplication of requested information and forms to complete, the inability to begin building a practice
as originally intended, and upset patients due to the provider not being in network with the patients’
health plans.

Decentralize and Foster Open Communication

Departmental buy-in for changing the status que requires bringing together all areas within the
organization who will be impacted by, or will impact, the incoming provider and identifying as a group
the initial customer (provider) and ultimate customer (patients). In addition, individual departments
need to understand how their part fits into the overall process and how they impact other areas,
patients, the provider, and the organization’s bottom line.

Alignment of Recruitment, Credentialing and Onboarding for Improved Provider Retention 1

Develop an Onboarding Committee
Departments which need to be a part of the process, and may need to be adjusted based on the
provider’s specialty, include:

 Recruitment  Information Services/Technology

 Credentialing/Medical Staff Office  Office Manager(s)
 Billing Department  Finance Department
 Risk Management  Nursing
 Human Resources  Marketing/Provider Relations

De-silo the Process

Each process should be broken down from initial contact with a provider from recruitment to the first
day a provider sees a patient in the clinic, identifying areas of redundancy, inefficiencies, and
communication breakdown. To de-silo the process, a single application used by multiple areas such as
human resources, hospital and health plan credentialing, and malpractice insurance application should
be evaluated for feasibility. This single step would be a significant provider, a cost saving measure and
collaborative opportunity for departments. Furthermore, the Credentialing/Medical Staff Office’s
database may become the central repository of all provider information shared by other organizational
departments.

Establish Timelines and Milestones

During the redevelopment of the onboarding and retention system, the team needs to establish
realistic timeframes for each task and hold each person/team responsible to the group for the timely
completion of each task. Changes in timeframes need to be communicated to the rest of the team so
appropriate adjustments can occur. An expectation of at least 150 days from receipt of a completed
application to a provider seeing the first patient in a clinic is not an unreasonable timeframe due to the
length of time to for hospital credentialing (average of 90 days) and health plan credentialing (90 – 180
days). Like project management, an onboarding navigator should be identified who is responsible for
ensuring each deadline is met, and if not, to help identify a solution to bring the task(s) back on track.

Create Real-time Communication Tools

Development of real-time communication tools is one of the most important endeavors for successful
alignment of the recruitment, credentialing and onboarding process. Communication processes will be
determined by the hospital’s IT infrastructure and budget, but an online portal should be explored to
allow for real-time information to the team, administrators and the provider. The system should map
milestones and expectations, and allow the provider to be part of the process. Providers need to be
held accountable for deadlines as well as their delay affects the success of the established onboarding
process and timeframes. The onboarding navigator should be speaking with the provider on a
frequent basis to both receive and provide feedback during the onboarding process. Frequent

Alignment of Recruitment, Credentialing and Onboarding for Improved Provider Retention 2

interaction with the provider during this time helps to foster a feeling of inclusion in the organization
and a sense of caring as his/her concerns are heard and address, which translates to increased job
satisfaction by the provider, better patient care and quality outcomes.

Re-evaluate and Adjust the Process as Needed

Solicit information from all team members and the provider after the onboarding process has
completed. This information should be reviewed by the onboarding committee who meet on a
frequent basis to ensure the success of the onboarding process. Adjust tasks and timeframes as
needed to meet the organizations goals. An efficient onboarding process improves provider retention
hospital revenues, and fosters synergy between departments.

References
An agency weighs in on ways to make the onboarding process easier. (2016). Medical Staff Briefing, 26(4), 9-10. Retrieved
October 4, 2017

Cors, W. (2015, August). Employed physicians as medical staff members. Medical Staff Briefing, 25(8), 7-8. Retrieved October
4, 2017

Daly, R. (2017, June 06). Hospital Employment of Physicians Stabilizes: Survey. Retrieved October 6, 2017, from Healthcare
Financial Management Association: https://www.hfma.org/Content.aspx?id=54498

Echo Solutions. (2016, November 03). Quality Onboarding = Quality Outcomes: 5 Tips to Build Strong Physician Retention.
Retrieved from http://blog.echo-solutions.com/2016/11/quality-onboarding-quality-outcomes-5-tips-to-build-
strong-physician-retention.html

Tiller-Hewitt Healthcare Strategies. (n.d.). Accelerating Engagement, Productivity and Retention. Retrieved October 4, 2017, from
Tiller-Hewitt Healthcare Strategies: http://www.tillerhewitt.com/accelerating-engagement-productivity-and-
retention/

6 October 2017 - Paige Gray, CPCS

Alignment of Recruitment, Credentialing and Onboarding for Improved Provider Retention 3