A hospital using this option must ensure that each outside employer's execution of these activities is done properly. A hospital may, for example, sample each outside employer's evaluation process, or examine the personnel records of each employee involved. Outside employers of in-hospital workers can, however, pose problems to hospitals. Some outside employers' personnel procedures are limited and informal. They often make no attempt to carry out formal evaluations of credentials or formal reviews of clinical competence.
Outside employers are also less likely to discipline or discharge incompetent employees.
In recognition of potential problems with outside employers, hospitals often protect themselves by requiring each outside employer to sign a statement that the employer takes complete responsibility for the actions of each of its employees and holds the hospital harmless for any liability. Develop a mechanism through which the hospital's own personnel system carries out the task of evaluating and monitoring competence. A hospital may establish a category of employees that does not receive compensation from the hospital but is instead employed and paid by outside organizations under contract with the hospital. The hospital's contract with each outside organization would state that such employees must receive job descriptions and periodic personnel evaluations from the hospital and require the organization to assign to the hospital only those employees who meet its competence standards. In addition to these suggestions, hospitals may develop other acceptable systems to evaluate and monitor AHPs employed by outside organizations.