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Peer Review Monthly: How are George Foreman and The Joint Commission alike?

Medical Staff Leader Connection, April 1, 2009

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Many people are not aware that former heavy-weight boxing champion George Foreman has 10 children, five of whom are boys he named George. While investigating this, I discovered that each has a unique nickname, but why not just give each boy a different name from the start?

The Joint Commission unfortunately took a similar approach to focused professional practice evaluation (FPPE) by applying the same term to two different situations.

The first situation is related to the focused evaluation of a physician currently on your medical staff for whom you have been conducting routine evaluations. If, during the course of a routine evaluation, the medical staff discovers a potential concern that requires a more in-depth assessment, it conducts a focused evaluation. With this form of FPPE, the assumption is that a potential problem exists, and the medical staff needs to evaluate it further.

The second type of FPPE is for new physicians on your medical staff or physicians requesting new privileges. In this case, the medical staff does not have first-hand information to confirm that these physicians are currently competent to perform privileges. With this form of FPPE, the assumption is that there is no immediate problem, but you are just checking to be sure. This type of FPPE was added on to the previous focused review standard with the assumption that the rest of the focused review elements would apply.

So what’s the big deal? As you can imagine, just as if you had two children with the same name, medical staffs are confused as they attempt to meet these standards, which share the same name but serve different purposes. The type of policies and procedures associated with each type of evaluation are quite different. In addition, the peer review committee usually carries out the first type of FPPE to evaluate the performance of a physician already on staff. The credentials committee usually conducts the second type of FPPE to evaluate new members or those seeking new privileges.

I think it's time we rename FPPE relating to new members or physicians seeking new privileges and give this type of evaluation its own section in medical staff standards. What should we call it? Here are few thoughts: setting specific competency evaluation (SSCE), new privilege competency assessment (NPCA), or privilege initiation competency check (PICC). Whatever is called, let’s name it for what it is trying to accomplish. If you have any ideas I would love to hear them.

(E-mail associate editor Liz Jones at ejones@hcpro.com with your suggestions.)

Robert Marder, MD, CMSL
Vice President
The Greeley Company

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