Considerations when starting an interdisciplinary APP committee

Start by finding a couple of physician champions and APPs who are regarded highly amongst their peer group and appear to be leaders, says Carol S. Cairns, CPMSM, CPCS. Begin to have this discussion with them—would they be interested in having such a structure? You might reach out to other organizations that have such a structure and look at what policies and procedures they have, if they have built it into their bylaws, and so on.

Then I would probably introduce it at two or three levels. I might begin with the credentials and quality committees’ chairs. This could lead to a discussion at the respective committee level. I would also discuss the advantages of such a committee with a couple of department chairs—especially those who are having difficulty assessing the competence of APPs on an ongoing basis. I would also ensure support for the concept from the VPMA/CEO and chief nursing officer. 

The APP interdisciplinary committee should not be an independent committee. The APP committee functions within the medical staff structure. Once several medical staff leaders are supportive (and hopefully, their respective committees have recommended the establishment of such a committee, then it is time for the medical executive committee (MEC) to consider the concept. The final step would be the governing body—generally through either the minutes of the MEC or a formal recommendation.   

Once the concept is supported and approved, then the committee’s purpose, membership, scope, and responsibilities should be spelled out in a bylaw or organizational manual policy. This will also provide protection for peer review processes under the state statutes as applicable.

The following functions are within the scope of responsibilities of APP interdisciplinary committees across the country:

• Review and recommend initial applicants to the department chair/credentials committee
• Identify opportunities to improve care
• Conduct peer review on APPs
• Establish standards for care
• Provide input into the privileges and clinical criteria for the various APP disciplines
• Create educational opportunities within the organization

Quite honestly, I have never seen nor heard of an organization that found it was a waste of time to create such a committee. Usually the C-suite, the medical staff, and the APPs find great value in the committee. You always start out with baby steps. When the listener asked if the committee should be temporary or permanent, if the initial support for such a committee is lukewarm, you might establish the committee on a temporary basis. Then after six months or a year, evaluate it and see if it is the appropriate structure for your organization. You might have co-chairs, for example a physician and an APP and that [APP] might be permitted to attend the credentials committee, with or without a vote.