The two types of credentialing errors
According to authors Richard Sheff, MD, and Robert Marder, MD, there are 12 principles of credentialing that every credentials committee members should know. These 12 principles are outlined in the Credentials Committee Essentials Handbook. This handbook is a quick and easy read for use in training or retraining members of your credentials committee. Even physicians who have been on the credentials committee for some time must be reminded of the important role they play in preventing negligent credentialing. It comes in packs of 5 so you can hand out copies to multiple members of your committee. Following is an excerpt from the 12 principles of credentialing:
Credentialing Principle #3: Beware the Two Types of Credentialing Errors
The third credentialing principle asks “How can the credentials committee make a mistake?” In general, there are two types of credentialing errors:
- Information errors: Information errors occur when information existed that would have affected a credentialing decision, but the medical staff was unaware. For example, if a physician was able to hide several malpractice cases, a license suspension, or a gap in training or experience, that would constitute an information error.
- Decision errors: Decision errors occur when the medical staff knows about malpractice cases, license suspensions, training gaps, etc., but fails to make a wise decision.
One of the credentials committee’s responsibilities is to evaluate applicants for initial appointments, reappointments, and new privileges. The committee should find no gaps in training, the privileges requested should be typical for the physician’s specialty, the National Practitioner Data Bank (NPDB) query should be clear, and references should all seem okay. The majority of files will sail through free and clear.
Occasionally, the committee will come across a file that sends up a red flag (e.g., a reference that leaves a line blank about the applicant’s professional behavior, or all of the recommendations are excellent except for one low score regarding compliance with policies). In such a case, the credentials committee’s job is to investigate the red flag and resolve the concern to the committee’s satisfaction.