Privileging is intended to authorize the practice of medicine. If a privileged practitioner (either a physician or an advanced practice professional) meets criteria to qualify for privileges requested it is assumed that the practitioner is clinically competent to perform the privileges requested. The goal of privileging is to ensure that clinical quality expectations are met and to protect the patient.
At initial application we collect data from the applicant and verify credentials and other practice related data required to assess their clinical competence to be granted the privileges requested. In order to be granted privileges the applicant must also meet the criteria specified on the privilege delineation. From there the application and related data is evaluated by medical staff leaders and finally is either approved or denied by the Board of Directors. The entire application process is concluded by sending the practitioner a “board letter” informing them of the outcome of the processing of their application.
A tremendous amount of time and effort goes into privileging practitioners. Some organizations regard the privileging process as largely a paper or file management process that is concluded when the board decision is made until the next reappointment. Other organizations seek to make privileging meaningful at the point of service...to move beyond meeting CMS, State and accreditation requirements and make privileging meaningful and beneficial for the patient. Here are some strategies that will extend the benefits of your privileging program to the point of service to ensure that benefits from your privileging program are realized.
Contemporary best practice is to make privileges granted available to clinical departments electronically via the Web. Despite this practice many medical staff offices continue to receive phone calls asking whether or not a practitioner is, in fact, privileged to provide a particular clinical service or perform a particular procedure. Privilege forms need to be developed with the end users in mind. Nomenclature needs to be shared across the organization. Here are a couple of examples regarding how that might be accomplished.
When reviewing case logs, most Medical Staff Services Professionals (MSSPs) are focused on whether the applicant meets privileging criteria – either specific numeric clinical activity requirements or general clinical activity representative of the privileges requested. An adjustment in surveillance posture and the way reports are reviewed/interpreted can provide additional valuable information. For example, the case log or OPPE report may reveal that the applicant for renewal is providing clinical services for which they are not privileged. Sometimes this is a disciplinary matter, but more frequently it is a miscommunication or misunderstanding regarding what was included in the delineation that was previously granted. This provides the MSSP with the opportunity to intervene and ask that the physician or APP cease performing the privilege until they meet the qualification requirements, complete the application process and are granted the privilege.
Perhaps the biggest opportunity afforded to the medical staff office manager to positively impact the relationship between privileging and clinical service is to perform regular environmental surveillance throughout the hospital. This allows the manager to identify clinical services that are poised for implementation at their organization. This avoids the situation where management is contacted by a physician or OR scheduler regarding a patient that is scheduled “tomorrow” for a procedure that is not even present on the privilege form. Here are some activities that can be undertaken to engage in anticipatory management of privileging.
To realize benefits of a privileging program at the point of service it is necessary for medical staff office management to get out of the medical staff office and regularly engage management in other areas of the organization as well as modifying their paradigm regarding how the program is administered. Besides providing the information necessary to ensure that delineations reflect contemporary practice and are effectively administered this networking can be stimulating and fun! Take the first step!