Taking a systemwide approach to FPPE
Care New England Health System is taking a systemwide approach to FPPE policies and forms. It’s a work in progress, but some elements are already in place, says Anne Marie Dion, CPMSM, director of medical staff services at Kent Hospital, in Warwick, Rhode Island, part of the Care New England system.
In addition to Kent Hospital, the Rhode Island-based network comprises Memorial Hospital in Pawtucket; Butler Hospital, a free-standing psychiatric hospital in Providence; and Women and Infants Hospital in Providence. Care New England has a blend of employed physicians in a subsidiary hospitalist group, which sees about 85% of the hospitals’ medical census, as well as a substantial number of private practice groups and individual physicians with staff privileges in one or more facilities.
To help unite best practices for FPPE and other medical staff processes, Care New England created a systemwide credentials committee to oversee the process. The committee informs hospital leadership that there is an expectation that they will participate in creating and fine-tuning FPPE processes, says Paul McKenney, MD, FACP, assistant chief medical officer at Kent Hospital and system director for credentialing and medical staff offices across Care New England since 2013. Before that, he oversaw credentialing at Kent Hospital for several years. Each hospital will continue to have its own credentials committee as well, with the systemwide group working to deploy revised forms and policies across the network.
As the revision process began, a key discussion item was whether or not to keep FPPE and OPPE under the umbrella of peer review. “Some organizations are trying to portray FPPE and OPPE as investigative or punitive, and we want it very clear that this is not the intent,” McKenney says.
Care New England also decided to avoid using a boilerplate approach in reviewing an individual’s background, training, and experience. For example, the system takes a tiered approach when an individual applies for robotics privileges. If the applicant has a current, active practice utilizing that privilege, he or she might be proctored for two cases. An established, experienced surgeon learning robotics as a new or expanded technique may have three to four cases proctored. A new surgeon who had robotics training during residency may need to have five or more procedures reviewed.
FPPE can include discussion with other care providers, including nursing staff; competency assessment for peer review can include chart review, direct observation, monitoring clinical practice patterns, measuring quality metrics, and external peer review.
Organizations that want to hone FPPE should involve both the chiefs and the credentials committee, Dion and McKenney say. Chiefs in Care New England hospitals are expected to help design FPPE and to make judgments as to when an FPPE is complete, if evaluation needs to be extended, or future training is necessary. “The credentials committee can still say they think FPPE should be extended, but in general, we are giving the chiefs a lot of that obligation to be responsible,” McKenney says.
Source: The FPPE Toolbox: Field-Tested Documents for Credentialing, Competency, and Compliance