FOUR PRINCIPLES FOR USE OF THE BC CREDENTIALS/PRIVILEGE REQUEST FORMS

1: Clarifying Terms, Responsibilities and Process

The current practice of medicine involves a complex determination of practitioner capability.

1. The Colleges1 continue to remain the primary regulatory bodies charged with monitoring entry to professional practice and provide a framework for ongoing validation of licensure.

2. Health Authorities and individual hospital departments are responsible for reviewing credentials as part of the process of application and reappointment to medical staff.

3. The typical2 process of requesting, granting or renewing privileges (the subject of this document) is outlined below:

  1. The practitioner requests privileges based on qualifications and current competence.
  2. The request is reviewed by a subject matter expert (i.e. Chief of Staff, Department Head) who verifies qualifications and current competency.
  3. The request then goes to the Medical Director of the Health Authority who ensures adequate validation activities have occurred.
  4. Next, the request goes to the Credentialing and Privileging Committees for independent review and to assess alignment with facility needs.
  5. The request is then forwarded to the HAMAC who will review the request and make a recommendationto the Board.
  6. Finally, the request and recommendation is sent to the Board for review and granting of privileges.

4. Practice assessment (including peer review and other methods) is yet another process under development that currently includes means to encourage life-long learning through endeavours such as the physician Maintenance of Competence program and will likely expand to provide more detailed assessments of performance on a regular basis rather than simply continue to be a response to an unfortunate incident.

2: The Credentials/Privilege Request Forms

These forms are intended to be simple, easy to understand, useful, documents that can be completed quickly. The forms are made up of two parts; the first concerns details regarding credentials and the second outlines the privileges you are requesting based on those credentials.

There are two questions we strive to address in the competency equation when considering privileges:

1. Have you done enough (examinations, procedures, tests, etc.) recently? (Currency)

2. When you did them, did you do them well? (Competency)

With respect to the "standards for currency", the number of exams or procedures suggested as a threshold is based on the College of Physicians and Surgeons British Columbia definition of current competence that requires an average of 8 weeks (or 320 hours) of work per year over the prior three years. The standards are developed by practitioners in the field and are believed to be fair and reasonable and are not intended as a barrier to practice or service delivery. The focus of the standard is on those who are close to or below the threshold, so the situation can be discussed,and not on the precise number for those who are well above the threshold. If, for example, the threshold for currency is 100 exams or procedures per year on average over the prior three years, appropriate answers for any one of the three years could be 0 or 50 or 100 or "over 200". The approximate number of activities performed is comprised from total practice and not by site. If the standards for currency are not achieved in the past three years, this will trigger a discussion.

Once a practice assessment process such as peer review is in place a column can be added to document current competence.

In the near future, the “forms” will be included in a province wide software solution, making web-based requesting and granting of privileges more efficient for everyone. By design, the forms are a work-in-progress that will require modifications as training, technology and the practice of medicine evolve.

3: Core and Non-core Privileges

Users of these documents are expected to apply their common sense and good judgement. Definitions of core and non-core skills may reflect a “typical practitioner”, but by no means will be able to capture the exact practice profile of every practitioner.

Core privileges are those activities or procedures which are permitted by virtue of possessing a defined set of credentials usually obtained as part of a standard training programme. Non-core privileges include activities and procedures which are outside of the core, which require specific training or certification or reflect advances in medical practice not currently reflected in the core.

In other words, the designation of core or non–core implies something about how widely certain skills are practiced or the existence of defined training associated with a particular skill. These specific characteristics may have little to do with the complexity or difficulty of any procedure; in fact some core skills are very difficult and some non-core ones are quite simple especially when done frequently. Furthermore, some individuals with broad-based skills may also be competent in a few highly specialized “non-core” areas; conversely, certain super-specialized individuals may no longer be competent in some basic “core” areas. The privilege request form allows for both situations where skills can be specifically documented to be included, or not included in a practitioner’s current privilege set as appropriate.

4: Requesting Privileges is Part of a Process

The claim and documentation of certain skills are necessary components of requesting privileges, but not independently, sufficient grounds for the granting of privileges. Other important factors which may be considered in the application and reappointment process include an analysis of context specific elements e.g. clinical need, cost-effectiveness, facility capacity and capability, and patient safety.

Please note that privileges are granted based on considerations of patient safety under normal circumstances. In the setting of risk to limb or life, the rules of privilege are not meant to constrain practitioners from acting in the best interest of a patient.

NB: MAKE SURE THAT YOU COMPLETE BOTH FORMS: CREDENTIALS AND PRIVILEGE REQUEST

1 College of Physicians and Surgeons, College of Dental Surgeons, College of Mid-Wives

2 While the number of steps in the privileging process may vary between four and six depending on the Health Authority, the actual tasks performed are consistent across all Health Authorities