What your credentials committee needs to know

The credentials committee plays a vital part in medical staff governance. The membership of the credentials committee consists primarily of physicians, and has input into key processes for credentialing, privileging, peer review, and quality. This committee is also charged with making recommendations for or against applicants' appointment and reappointment to the medical staff.

However, in the Credentials Committee Essentials Handbook, authors Richard A. Sheff, MD, and Robert J. Marder, MD, pointed out "there is often a disconnect between what the medical staff bylaws say credentials committee members should do and what they actually do."

Whether or not there's a disconnect in your organization's credentials committee functions, it's important to keep committee members up to speed on new developments in privileging criteria, the status of practitioners, and other key information. If a disconnect does exist, MSPs and medical staff leadership have some options for reconnecting committee activities with expectations.

Take time to teach

Education is on the agenda at American University Beirut Medical Center (AUBMC), a Joint Commission International-accredited hospital in Beirut, Lebanon.

"We have incorporated educational sessions into our credentialing committee meetings, where a particular topic is decided upon and a short, five- to 10-minute presentation is done by the medical staff office to touch on the most important issues on this subject," says Diana El Banna, medical staff officer at AUBMC.

Previously, El Banna says the medical staff office tried to send weekly articles to the credentials committee members for educational purposes, but found that nobody was reading them. "We decided on an alternative approach, and [committee members have been] more receptive," she says.

Recent topics have included considerations that go into a leave of absence policy, and the components of physician disclosure of information. The AUBMC credentials committee meets once a month, and the presentations are usually done at the end of the committee meeting, after the committee's agenda has been completed, she says.

Click here to see a sample AUBMC educational presentation. 

Source: Credentialing Resource Center Journal, October 2o15.