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Tip of the week: Define privileges in a way that allows your organization to address the competency equation

Medical Staff Leader Connection, September 15, 2011

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This week’s tip is from Measuring Physician Competency, by Robert Marder, MD.

Many organizations have adopted privilege delineation forms that list procedures and include a column in which the applicant should note how many times he or she has exercised the privilege over the past two years. This approach can be flawed. The information that most applicants provide is simply a guess and therefore inaccurate. Second, the information is rarely verified. Most important, many organizations that ask for this information have not determined the number of times an applicant must have performed a particular procedure to be eligible to request the procedure in question. Therefore, the information is presented to a department chair, who either ignores the number of times the applicant claimed to have performed the procedure requested or makes a subjective recommendation.

Instead, it needs to be determined what data is helpful in evaluating competency. Develop a small group to review the new privilege delineation form. The group needs to determine what data will be helpful in evaluating whether a practitioner is competent to exercise the privileges on the privilege delineation form by answering the question, "What would you want to know if you were being asked to recommend these privileges?"

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