Four steps to privileging excellence

It’s important for credentials committee members to understand that they are involved directly or indirectly in developing an excellent privileging process. Privileging involves four distinct, ongoing steps:

1. Determining which clinical procedures or treatments the organization will offer and support.
2. Determining what training, skills, behaviors, and experience are required for a practitioner to be authorized to perform each clinical procedure or treatment.
3. Determining whether applicants for privileges meet these requirements and then officially granting or denying the requested privileges.
4. Monitoring the individuals who are granted privileges to ensure their continued competence and practice within the scope of privileges granted.

Before any privileges may be granted, there must be clarity about the scope of clinical services that the organization will offer. Ultimately, the governing body must make this decision, although both the medical staff and administration can offer advice. No privileges should be extended for clinical care that is not offered at the hospital.

Once the scope of offered privileges is established, the next step is to create the criteria that will be attached to those privileges. These criteria include education, training, clinical activity, and quality outcomes.

Education and training include attending professional school and earning the appropriate degree, participating in an accredited postgraduate training program, including residency and fellowship, and undergoing any other formal, recognized training by specialty societies, such as American College of Emergency Physicians–endorsed training for emergency bedside ultrasound. Education training may also include board certification; continuing education (i.e., CMEs/CEUs); and recognized certifications. Clinical activity might include the numbers and types of patients admitted/discharged and treated, consultations performed, and procedures performed.  Quality and outcomes information includes mortality and complication rates, case reviews, or other information related to the specific privileges exercised.

The more specific the above criteria are for a given set of privileges, the easier it is to assess whether an applicant meets your organization’s requirements and whether he or she should therefore be granted the requested privileges. If an applicant does not meet the requirements, then the organization is not denying privileges to that individual; rather, it cannot process the privilege request. Because there is no denial, there is also no right to a formal hearing. Remember, only deny if you have to, and only do so for lack of demonstrated competency.

Finally, organizations need to monitor individuals for their continued competency in exercising their privileges. Such monitoring is conducted through the FPPE and, most importantly, the OPPE mechanisms.