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Manage committee controversy

Credentialing Resource Center Connection, August 14, 2003

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Dear Credentialing Colleague:

The credentials committee meets to review the files of a number of new medical staff applicants. It quickly dispenses with the first half dozen, but finds its members at odds over the seventh. All members except one believe the applicant is well qualified and should be recommended to the medical executive committee (MEC). After all, she completed "medical or osteopathic school" and residency training in general surgery, is board admissible, has great references, shows no history of disciplinary action or malpractice suits, and wants to establish a practice in town.

"What's the problem?" asks the credentials committee chair.

"I just don't believe her education and training are up to our standards," says the wary member.

"You'll have to be more specific than that," responds another member. The wary member explains that the applicant is not an MD and received her training at a hospital no one has ever heard of.

Much discussion follows, but the other members are not able to persuade the "one" to come around. A vote takes place: 6 to 1 in favor of the applicant. Quickly, the chair asks for a review of the credentials policy and finds that any member may submit his or her objections in a written report to the MEC for its consideration. The wary member declines the offer but demands that his vote be put "on the record."

The chair accepts this choice, but again seeks the rationale behind the negative vote, as he will be required to explain the split vote to the MEC. The "one" says he'll be glad to attend the MEC meeting to explain in person.

The MEC meets the following week, and the wary member does not show up. The credentials committee chair attempts to explain the split vote. The MEC then unanimously recommends the applicant and life goes on.

Occasionally there will be differences of opinion on a credentials committee or MEC. Policies and procedures should provide guidance on the course of action that should follow. Allow for dissention, discussion, and differences in opinion, but be businesslike about it. Inform "wary members" that they must explain their position in writing so higher authorities can consider it.

A good chair will take every opportunity to educate members about the standards and expectations of the staff and hospital. Clearly, denial based on a lack of appropriate education or training should be avoided through the creation of and adherence to predetermined membership and privileging criteria.

That's all for this week.

All the best,

Hugh Greeley

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