Applying Critical Thinking Skills to Avoid Confirmation Bias in Credentialing Decisions Session Code: MN09 Time: 12:45 p.m. 2:15 p.m. Total CE Credits: 1.5 Presenter: Kathy Matzka, CPMSM, CPCS
Applying Critical Thinking Skills to Avoid Confirmation Bias Applying Critical Thinking Skills to Avoid Confirmation Bias Kathy Matzka, CPMSM, CPCS Kathymatzka.com Confirmation Bias Tendency to seek out and interpret information in a way that confirms one's own beliefs or preconceptions Biases can occur in the collection, interpretation or recall of information 2 Avoiding Confirmation Bias Goal = Impartial collection and evaluation of evidence leading to an unbiased conclusion Avoid building of a case to justify a conclusion already drawn 3 Kathy Matzka, CPMSM, CPCS www.kathymatzka.com 1
Applying Critical Thinking Skills to Avoid Confirmation Bias Why is this important? Confirmation bias can lead you to make poor decisions based on debatable information 4 Steps in Making a Decision Step 1 Describe the Problem Step 2 Investigate possible solutions Step 3 Analyze options Step 4 Make the best choice 5 Critical thinking skills Play devils advocate - list views which are opposing to your own opinions Gather as much information as possible before determining whether or not your hypothesis is true Know the difference between fact vs. opinion 6 Kathy Matzka, CPMSM, CPCS www.kathymatzka.com 2
Applying Critical Thinking Skills to Avoid Confirmation Bias Fact vs. Opinion Scenarios Exercises 7 What if They Won t Listen? It is difficult to get a man to understand something, when his salary depends upon his not understanding it. - Upton Sinclair 8 Transparency free from pretense or deceit easily detected or seen through readily understood characterized by visibility or accessibility of information especially concerning business practices - Merriam-Webster s Dictionary 9 Kathy Matzka, CPMSM, CPCS www.kathymatzka.com 3
Applying Critical Thinking Skills to Avoid Confirmation Bias The Emperor's New Clothes 10 Transparency in Credentialing & Privileging Processes Accessibility of policies and procedures by patients, staff, etc. Publish! (not peer review, of course) Internally (Intranet) Externally (Internet Facility Web Page 11 Advantages of Transparency More accountability leads to stricter adherence to policies Patients get information to utilize in making informed healthcare decisions Boost public perception of the credibility of the organization Marketing tool 12 Kathy Matzka, CPMSM, CPCS www.kathymatzka.com 4
Applying Critical Thinking Skills to Avoid Confirmation Bias Disadvantages of Transparency Will be held to the published standard both legally and ethically 13 Maintaining Continual Compliance Training for medical services professionals, physician leaders, administrators, and governing body members Keep up with accreditation standards and regulatory requirements Audit policies and procedures for compliance 14 Questions 15 Kathy Matzka, CPMSM, CPCS www.kathymatzka.com 5
Applying Critical Thinking Skills to Avoid Confirmation Bias End of Story So he drew himself up and walked boldly on holding his head higher than before, and the courtiers held on to the train that wasn't there at all. -Hans Christian Anderson 16 Kathy Matzka, CPMSM, CPCS www.kathymatzka.com 6
Applying Critical Thinking Skills to Avoid Confirmation Bias Presented by: Kathy Matzka, CPMSM, CPCS Writer/Speaker/Consultant 1304 Scott Troy Road Lebanon, IL 62254 kathymatzka@kathymatzka.com www.kathymatzka.com Phone (618) 624-8124 Fax (618) 624-8124
About the Presentor: Kathy Matzka, CPMSM, CPCS is a speaker, consultant, and writer with over 25 years of experience in credentialing, privileging, and medical staff services. She holds certification by the National Association Medical Staff Services (NAMSS) in both Medical Staff Management and Provider Credentialing. Ms. Matzka worked for 13 years as a hospital medical staff coordinator before venturing out on her own as a consultant, writer, and speaker. Ms. Matzka has authored a number of books related to medical staff services including Medical Staff Standards Crosswalk: A Quick Reference Guide to The Joint Commission, CMS, HFAP, and DVN Joint Commission Standards, Compliance Guide to Joint Commission Medical Staff Standards, and The Medical Staff Meeting Companion Tools and Techniques for Effective Presentations. For eight years, she was the contributing editor for The Credentials Verification Desk Reference and its companion website The Credentialing and Privileging Desktop Reference. She is co- Verify and Comply: Credentialing and Medical Staff Standards Crosswalk, Sixth Edition. Education Committee developing and editing educational materials related to the field including CPCS and CPMSM Certification Exam Preparatory Courses and Study Guides, CPMSM and CPCS Professional Development Workshops, Standards Comparison Grid, and NAMSS Core Curriculum. These programs are essential educational tools for both new and seasoned medical services professionals. She also serves as instructor for NAMSS. Ms. Matzka shares her expertise by serving on the editorial advisory boards for two publications - Briefings on Credentialing, and Credentialing & Peer Review Legal Insider. Ms. Matzka is a highly-regarded industry speaker, and in this role has developed and presented numerous programs for professional associations, hospitals, and hospital associations on a wide range of topics including provider credentialing and privileging, medical staff meeting management, peer review, negligent credentialing, provider competency, and accreditation standards. In her spare time, Ms. Matzka takes pleasure in spending time with her family, listening to music, traveling, hiking, fishing, and other outdoor activities.
Table of Contents Confirmation Bias... 1 Applying critical thinking skills... 1 Fact vs. Opinion... 2 Fact vs. Opinion Exercise... 2 Scenario #1... 3 Scenario #2... 4 Understanding Transparency... 5 Advantages of Transparency... 5 Maintaining Continual Compliance... 6... 7
Confirmation bias is a tendency to seek out and to interpret information in a way that confirms one's own beliefs or preconceptions. Raymond Nickerson describes this phenomenon as follows: come to an unbiased conclusion and building a case to justify a conclusion already drawn. In the first instance one seeks evidence on all sides of a question, evaluates it as objectively as one can, and draws the conclusion that the evidence, in the aggregate, seems to dictate. In the second, one selectively gathers, or gives undue weight to, evidence that supports one's position while neglecting to gather, or 1 Confirmation bias can be dangerous in the credentialing and privileging processes because it can lead people to make poor decisions based on debatable information. One way to avoid confirmation bias is to apply critical thinking skills in credentialing and privileging decisions. Instead of only looking at one opinion, all views should be carefully come up with all rationales that do not support your decision. Using a four step process to come to a decision can be helpful. Step 1 Describe the problem Step 2 Investigate possible solutions Step 3 Analyze options Step 4 Make the best choice 1 Nickerson, Raymond, Confirmation Bias: A Ubiquitous Phenomenon in Many Guises, Review of General Psychology, 1998, Vol. 2, No. 2, 175-220 Applying Critical Thinking Skills to Avoid Confirmation Bias 1 Kathy Matzka, CPMSM, CPCS www.kathymatzka.com
When evaluating information, be cognizant of fact vs. opinion. Many comments received when credentialing are based on opinion rather than fact. While the opinions of peers are important, decisions made based on facts are easier to justify. When evaluating whether a comment is a fact, look to see if the comment is based on information, documents and other material that demonstrate the existence of a fact or the truth of the comment. Fact vs. Opinion Exercise Instructions: Read the question and determine if the statement is appears to be based on fact or opinion. Circle your answer. 1. Dr. Thomas is a personable physician who will Fact Opinion make a great addition to your staff. 2. According to patient opinion polls, Dr. Thomas Fact Opinion spends adequate time with his patients and answers their questions. 3. According to a Fact Opinion surgical complication rates for laparoscopic cholecystectomy were under the national and facility benchmarks. 4. Fact Opinion has received training in all privileges he has requeste (Letter from residency program director.) 5. Dr. Thomas is well trained. (letter from peer) Fact Opinion 6. The credentials file reflects that Dr. Thomas Fact Opinion has not been subject to disciplinary action while at this facility. 7. Dr. Thomas is caring and compassionate. Fact Opinion 8. Fact Opinion indicates that disciplinary action was taken due to failure to meet bylaws requirements for minimum amount of professional liability insurance. 9. I believe that Dr. Thomas had some problems Fact Opinion at the hospital regarding medical records completion (letter from peer) 10. I would not refer my family members to Dr. Thomas. Fact Opinion Applying Critical Thinking Skills to Avoid Confirmation Bias 2 Kathy Matzka, CPMSM, CPCS www.kathymatzka.com
The board has charged the hospital CEO with responsibility for recruitment of an orthopedic surgeon. A candidate who will be completing an orthopedic surgery residency in a couple months is interviewed by the CEO. The CEO makes a few phone calls and receives positive verbal recommendations from physician peers whose names were provided by the candidate. The CEO reports at the next board meeting that the recruitment efforts were successful and a well-qualified applicant has been identified. The board congratulates the CEO on his efforts and recommends that a contract be offered to the new recruit. The hospital expends a significant amount of funds and resources in negotiating a contract and relocating the surgeon and family to the community. When conducting the credentialing activities for program. In addition, two of the peers provided by the applicant did not complete the do not address the questi address the competency or behavior of the applicant. Step 1 Describe the problem Step 2 Investigate possible solutions Step 3 Analyze options Step 4 Make the best choice Applying Critical Thinking Skills to Avoid Confirmation Bias 3 Kathy Matzka, CPMSM, CPCS www.kathymatzka.com
The criteria for granting of privileges as documented in the medical staff bylaws require that all medical doctors must be board certified by a member board of the American Board of Medical Specialties or the American Osteopathic Association; or for newly trained physicians, that they achieve this board certification within 5 years of completion of their residency. The hospital has a critical shortage of emergency physicians and is actively recruiting. A recruiter contacts the CEO regarding an interested who completed an ACGME-approved emergency medicine training program and has fifteen subsequent years of emergency medicine experience. The hospital contracts with the physician and, based on a critical patient care need, in accordance with medical staff policy, the Medical Staff President recommends and the CEO grants temporary privileges pending receipt of all primary source verification. In collecting the outstanding verifications, it is determined that the board that granted certification in emergency medicine is not a member board of the American Board of Medical Specialties or the American Osteopathic Association. No other concerns are identified during the credentialing process. As the physician has been working for several and is told that the physician appears to be providing appropriate care. He also asks for a review of patient records, which does not turn up any concerns. Step 1 Describe the problem Step 2 Investigate possible solutions Step 3 Analyze options Step 4 Make the best choice Applying Critical Thinking Skills to Avoid Confirmation Bias 4 Kathy Matzka, CPMSM, CPCS www.kathymatzka.com
Merriam- cessibility of information 2 Transparency in the credentialing process refers to allowing the general public access to the processes the organization uses to assure that only qualified, competent individuals are allowed to provide patient care, treatment, and services. Transparency does not mean that all materials received in the process of credentialing and privileging are available for review by the general public. Peer review statutes enacted by most states assign strict confidentially to these materials. For instance in Illinois, the Medical Studies Act provides reference or other third party confidential assessments of a health care practitioner's 3 Advantages of Transparency Publishing its policies and procedures for public review may result in benefits to the organization. Most patients have little or no understanding of the credentialing functions performed by the organization. Rather, the community relies on the administration and governing body to employ a reasonable standard of care to ensure that employees and physician leaders perform functions in keeping with the expectations of community. Organizations that operate in such an environment of public trust hold a high degree of accountability. While a Medical Services Professional (MSP) typically performs credentialing and privileging functions in conjunction with medical staff leaders, the ultimate legal accountability for the organization lies with its governing body. Publishing the credentialing and privileging policies and processes will cause a greater degree of accountability within the organization, which can lead to a stricter adherence to these policies. Providing public access to the credentialing and privileging processes utilized by the organization assures that potential patients receive important information they can utilize in making informed healthcare decisions. This can boost public perception of the credibility of the organization. It can also be used as a marketing tool. 2 Miriam-Webster Online http://www.merriam-webster.com/ 3 735 ILCS 5/8-2102 Applying Critical Thinking Skills to Avoid Confirmation Bias 5 Kathy Matzka, CPMSM, CPCS www.kathymatzka.com
In order for an organization to meet a reasonable standard of care, its credentialing and privileging practices must be based on applicable accreditation standards and state and federal regulations and these practices must be followed. Most organizations have bylaws, policies, and procedures that address these practices, but many fall short in strictly adhering to the established requirements. Medical services professionals, physician leaders, administrators, and governing body members must be provided adequate training so that they understand their responsibilities in credentialing and privileging. This training should be an ongoing process that continues throughout their career. Those responsible for credentialing and privileging must keep abreast of accreditation standards and regulatory requirements. A process should be developed whereby access to these documents is readily available. When changes occur, policies and procedures should be evaluated to determine if changes are necessary to keep practices current with standards and regulations. Another significant aspect of accountability is development of a process of audit or evaluation to check that procedures are being followed and standards upheld. In auditing credentialing and privileging processes, this evaluation should include strict adherence to the application of criteria for appointment and privileges, meeting timeframes for review and approval, meeting proctorship and monitoring requirements, and having all necessary documentation in place prior to making a credentialing or privileging decision. Applying Critical Thinking Skills to Avoid Confirmation Bias 6 Kathy Matzka, CPMSM, CPCS www.kathymatzka.com
4 which illustrated how people are unwilling to state an obvious truth out of fear of appearing stupid or unfit for their job. The story involves an Emperor who was very fond of new clothes, being taken advantage of by two swindlers who claimed to be able to make a material that was not only beautiful, but that the clothes made from it could not be seen by someone who was stupid or not fit for his post. The Emperor thought this was a great idea, as he felt he could use the clothes as a tool to determine which of his underlings were stupid or unfit. Although no one, including the Emperor, could see the non-existent clothes, none would admit to this as they did not want to appear stupid or unfit. Instead, they all exclaimed of the beauty and magnificence of th existent train of his cape. All the townspeople raved about the new clothes as they did not want to admit that they couldn't see anything or it would be known that they were was either d it eventually got to the Emperor. Although the Emperor had the uncomfortable feeling that what they were saying was true, he felt he had to go through with the procession. Anderson ends this story with the dly on holding his head higher than before, Sometimes mistakes are made in the decision to grant privileges or in the credentialing and privileging process. It is important to identify and correct these mistakes internally, before admit that a decision was wrong, or confronting a superior about a decision made. Although these can be uncomfortable actions, failure to admit and correct mistakes can lead to public care. All credentialing and privileging decisions should be made in such a way that the organization can be proud of putting them on display to the public. 4 Hans Christian Andersen, Tales, The Harvard Classics, 1909 14 Applying Critical Thinking Skills to Avoid Confirmation Bias 7 Kathy Matzka, CPMSM, CPCS www.kathymatzka.com