These Four Steps Revitalized the Onboarding Process at Johns Hopkins All Children’s Hospital

Since the overhaul, the number of hospital-employed providers who are active with health plans has increased by nearly 30 percentage points.

This article is excerpted from an article originally published on the Credentialing Resource Center, June 19, 2017.

Practitioner onboarding means different things to different people, depending on which department of the healthcare organization they work in. It can be hard to take a step back and look at the overall picture of provider onboarding when you are focused on your piece and meeting your own deadlines and responsibilities. However, taking the time to analyze this big picture can completely transform the onboarding process and ultimately improve everyone’s view of the healthcare organization—including patients’.

Just take it from Kristine Kirstein, MHA, who helped reinvigorate the onboarding process at Johns Hopkins All Children’s Hospital (JHACH), in St. Petersburg, Florida.

Prior to the dedicated overhaul, JHACH’s provider enrollment process took an average of six months. Due to this lengthy turnaround, the organization was dealing with patients who, upon coming from out of state to see a particular practitioner, either had their scheduled visit delayed or had to see someone else—which led to practitioner and patient dissatisfaction. 

In investigating the hospital’s provider enrollment process, Kirstein, who is the academic program manager for John Hopkins University at JHACH, used the Lean Six Sigma tool of workflow to depict the entire onboarding process. Kirstein started realizing that data (sometimes duplicative) was housed in many places. “Providers were getting really confused and, I think, frustrated with the entire process. We heard from providers, ‘I have given you that piece of information five times.’ ”

So Kirstein decided to gather the provider enrollment and medical staff services departments at the table to discuss their parts in the process and the information they collected. The group compared the two functions to understand when and where certain pieces of information were collected and to identify commonalities. Based on this discussion, the team took four key steps to streamline the onboarding process:

1. Established a biweekly time to connect with all individuals involved in onboarding. This ensured all questions were addressed in real time and decisions were made with the appropriate people present.
2. Brought the right people in the room or on the phone. The team established a conference line, which increased participation because some participants only needed to hear about 1–2 incoming providers. The conference call made it easier for them.
3. Created a tool that supported the key milestones of the onboarding process. The group built a tracking spreadsheet to document developments related to recruitment, clinical privileges, primary source verification, enrollment, and other key onboarding activities.
4. Ensured access to the tool for continual updates/edits.

These strategic interventions have brought tangible results. In February 2015 (prior to the onboarding overhaul), less than 50% of all employed providers were active with payers. By February 2016, this increased by 20 percentage points. By the end of 2016, more than 77% of employed providers were active with payers, while the volume of providers continuously increased.