Proctoring and FPPE: Doctors Hospital of Manteca

Doctors Hospital of Manteca, a 73-bed facility, is part of Tenet Healthcare and has an active medical staff of about 75 (around 184 when those with courtesy privileges, consulting physicians, and provisional practitioners are included in the count). The organization has had a hospitalist program for just over a year; its hospitalists are admitting practitioners.

"We have had a [proctoring] policy in place for a very long time. Before the term 'FPPE' came out, hospitals in California had been doing proctoring for 20-plus years. We at DHM also have established guidelines that spell out whom and what is to be proctored," she says.

However, "we found that the general forms for medical proctoring and surgical proctoring that had been developed many years ago had become outdated," says Terrell. Those forms no longer applied to all practitioners, such as consultants. One example was the surgery proctoring form, which didn't apply to invasive procedures, such as those related to pain management.

"Some proctors had complained to me that they didn't like filling out the forms we had because it the questions didn't apply. I got frustrated having old forms that were no longer applicable," she recalls. "So I started thinking about what would work here for the doctors. I looked at sample forms from my Tenet colleagues and anything I could find on the Internet." She took "bits and pieces" from different sources and put together an improved set of documents. "Next, I took them to my medical staff leaders, and they liked what I did."

Guidelines by specialty

Where the outdated evaluation forms were overly general, Doctors Hospital of Manteca now has an improved set of forms asking specific questions that do apply to the practitioner that is being evaluated. When a new practitioner starts at DHM, there are specific cases/procedures that must be proctored. "For some specialties it may be the first 10 cases or consultations or the first 10 cases to include specific types of procedures," says Terrell.

"I just wanted to cover everything. For example, on the Admitting Practitioner Evaluation form, I included sections for evaluating diagnostic workup/patient management, professional conduct, and general competencies. For clarity, I attached an explanation for each of the six general competencies to the form," she says.

Proctors are sent a letter from the department chair informing them of their assignment, and they're a provided with proctoring reports to complete (see p. 6). Department chairs review the completed proctoring reports to see if there are any concerns that they must address with the practitioner. If there are no concerns, the reports are compiled until the practitioner has met the requirements. "Then we have the proctor complete an overall evaluation form and submit their recommendation to continue proctoring or release from proctoring," Terrell says.

The proctor's recommendation is presented to the department chair, who then makes his or her recommendation to the credentials committee to continue or release from proctoring.

The policy includes OPPE triggers for FPPE, including sentinel events and a trend of performance deficiencies identified through peer review. If reviews show four or more cases with the same deficiencies based on ratings for quality, utilization, and behavior, that's a trigger, says Terrell.

Performance issues are scarce because both proctors and practitioners know what is expected of them, and there are policies and procedures in place to help steer the process. Terrell cites a good rapport with the medical staff as another key to her organization's success.

Her advice for other MSPs? "Be proactive to changes. I [made changes] out of frustration because the forms were so old."

Also, when you find what works, share it, she says.