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Focused professional practice evaluation: Don't overdo it!

Medical Staff Leader Connection, August 26, 2010

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Several months ago, I visited a medical staff that was reviewing every case for every new practitioner on staff for six months to satisfy the FPPE requirement. When I asked them why they felt the need to do this, they looked at me quizzically. I turned to the chair of orthopedics and asked, “If I was an experienced orthopedic surgeon whom you were familiar with and I came with 20 years of solid quality data, an impeccable professional reputation, great references, and you scrubbed with me on a difficult hip reconstruction case, how many similar cases would you have to review to confirm my competence?” He replied, “One.” I then asked, “Then why do you feel the need to perform all of this unnecessary and redundant work to satisfy an accreditation standard when you fulfilled the intent of this standard after the first case?” He stated that he didn’t realize that they had a choice on how to fulfill the standard.

This issue of overdoing it when fulfilling FPPE comes up frequently. The Joint Commission issues a standard and everyone rushes to implement it in a manner that either over-interprets the standard or creates an enormous amount of unnecessary work.

Thus, the intent of FPPE (MS.08.01.01) is to confirm competence for practitioners with new privileges and to confirm whether concerns regarding existing privileges are valid. Thus, a good question to ask is: How can we fulfill the intent of FPPE in a way that protects patients while minimizing the effect on scarce resources?

In the spirit of this question, I provide the following suggestions:

• Be flexible in your approach. Well established and experienced practitioners require far less effort than new practitioners or those who request high-risk privileges.
• Create a smaller minimum number of cases to evaluate (e.g., two) and then allow the department/clinical service chair to determine the length or volume of further evaluation or review based on the initial findings.
• Use prospective and retrospective review more frequently than concurrent review, which is far more taxing of resources. Prospective and retrospective reviews are, in short, chart review, while concurrent review requires a proctor. 
• Use reciprocal or preemptive reviews whenever possible. Reciprocal reviews are reviews conducted at other organizations using your organization’s forms. Preemptive reviews are conducted by a residency program or another organization before joining your program or organization. These types of reviews will minimize your organization’s workload.
• Use technology (e.g., teleproctoring, simulation, procedure recording, etc.) whenever possible to minimize your workload.
• Be pragmatic. Focus on the intent of the standard, which is to confirm competence and protect patients from potential harm, and not on the operational details of your implementation process. Getting to the right solution is of far greater importance than engaging in an overly cumbersome process.

FPPE should be of great value to your medical staff and organization in quickly and effectively confirming competence and in providing safe high quality services to your patients. How you implement it is up to you. Don’t overburden yourself or your medical staff by completing unnecessary or redundant work. Like our other challenges in healthcare, try to do more with less and focus more on the intent of the standard and not the path you use to get there.

Jonathan H. Burroughs, MD, MBA, FACPE, CMSL, is a senior consultant with The Greeley Company, a division of HCPro, Inc., in Marblehead, MA.

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