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Reappointment is not a quality control mechanism

Credentialing Resource Center Connection, March 4, 2004

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Dear Credentialing Colleague:

It has been suggested in the past that hospitals must strengthen their reappointment process and provide department chairpersons more information, (such as aggregate data, results of peer review, clinical activity summaries and the like) to assist them in determining if a physician continues to be qualified for appointment and a grant of clinical privileges. 

More information may indeed be necessary but not only at the time of reappraisal. It is simply illogical to design and operate a system that would allow an incompetent or unqualified physician to remain on staff with privileges, authorizing the treatment of patients, simply because his or her reappointment date had not arrived.

As I have suggested in the past, reappointment is a time to legally reaffirm what the hospital and medical staff leaders have known all along: That the physician is competently providing care to hospitalized patients. [The process may also be used to adjust staff category, suggest that records need more attention, provide one last chance concerning behavioral problems, adjust privileges due to long periods of minimal clinical activity, etc.]

The reappointment period should not be that point in time when the staff (theoretically due to the heightened scrutiny paid to the physician) determines that his or her clinical work is substandard and that a danger is posed to patients. If this condition were present it is highly unlikely that it arose on exactly the day the physician's reappointment request reached the medical executive committee. It is more likely that evidence of declining skills or poor performance was first noticed months ago, triggered by reports from staff leaders, the peer review system, or observations of other healthcare practitioners. It should have been acted upon then and not simply placed in a file to be withdrawn and considered at the time of reappraisal.

Reappraisal and reappointment every two years is performed primarily because it is required by various private and governmental agencies. It long ago lost its utility except as a means to meet these requirements. The actual process within a medical staff should continuously assure that a physician is both qualified for appointment and is competent to exercise granted those privileges granted.

The process as we know it is not a quality control mechanism, it is simply a response to requirements created long ago. The human resources practices of all businesses in America presume that employees will work until they either voluntarily leave or are involuntarily terminated.  Annual performance appraisal is an opportunity to provide feedback and (though despised by E. W. Deming) adjust compensation. Employees are not required to reapply for their jobs each two years. Why should physicians?

That's it for this week

All the best,

Hugh Greeley

http://www.greeley.com/seminars/

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