6 steps to resolve privileging turf battles

The number of privileging disputes occurring in hospitals is growing rapidly. It’s easy to understand this trend if you examine how medicine has evolved. In the “good old days,” physicians of all specialties had a defined area of turf on the playing field and specialties didn’t cross those boundaries. The acrimony that can arise from such disputes often leaves scars and wounds on medical staffs that may not be prepared to deal with the change and conflict associated with this challenge. The following steps will help your medical staff as it deals with challenges to conventional privileging:

1. Assign responsibility for dispute resolution to a small, very experienced committee. Ideally, the credentials committee or perhaps a medical staff standards committee must be charged with the responsibility of "owning" resolution of all privilege disputes.
2. Research, research, research any and all matters or disputes concerning the granting of clinical privileges. Assign a staff person to research and prepare a full background paper concerning the issue at hand. This step is absolutely critical to effective dispute resolution due to the fact that the committee needs unbiased, objective information concerning the issue in order to dialogue effectively with parties to the dispute.
3. Involve the disputing parties. At the conclusion of research, a member of the credentials committee should facilitate a discussion between or among the involved parties in an attempt to solicit a consensus recommendation concerning the amount of education, training and experience necessary for the safe and effective performance of the procedure in question. If the involved parties decline the invitation to meet, then each party should be requested to advise the credentials committee, based upon their own knowledge and with reference to the research concerning the amount of education, training, and experience they believe is necessary to perform the procedure safely and effectively. A firm time period should be identified for receipt of their recommendation.
4. Have the credentials committee review recommendations. If a consensus was reached, the job of the credentials committee is to test the consensus recommendation against the following criteria:
   • If a physician with this amount of education, training, and experience were granted privileges at this facility, would we be comfortable referring a friend to the practitioner? If the answer to this question is yes, the credentials committee should proceed to recommend adoption of the rule. If the answer is no, the credentials committee's job is to craft a rule, based upon review of the research and after consideration of the various recommendations that will, in their opinion, serve to ensure safe and effective provision of patient care.
   • It may be necessary to touch base once again with the disputing parties and request that they document their objections to a proposed rule in formal minority reports that can be considered at a later point in the process.
5. Consider the proposed rule by the medical executive committee with subsequent recommendation (if controversial) to the board of directors. It is absolutely vital at this point that the policies and procedures utilized by the credentials and executive committees preclude procrastination, end runs, serious consideration of "threats," or departmental filibusters. If such activities are tolerated, it is likely that the dispute will escalate into a battle, if not a war.
6. Each of the above steps should be codified into a formal policy and procedure utilized by the institution concerning the development of standards for granting and regranting of clinical privileges. Such a policy should be recommended by the credentials committee, executive committee, and approved by the board. Once approved by the board, it should be followed absolutely in the resolution of any dispute concerning the granting of clinical privileges.

Source: The Medical Staff Leader's Practical Guide: Survival Tips for Navigating Your Leadership Role