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FPPE revisited

Medical Staff Leader Connection, November 3, 2011

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Last month, I discussed the effectiveness of OPPE since The Joint Commission implemented this standard for peer review four years ago. This month, I want to look at the effectiveness of the other standard, which was implemented a year later: FPPE for new members or privileges. 

Initially, The Joint Commission created some confusion by labeling the follow-up of concerns identified by OPPE with the same term used for evaluating new members of the medical staff. With the first form of FFPE, a potential problem exists and your medical staff needs to evaluate it further.

The second type of FFPE 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 the privileges they request. With this form of FFPE, the assumption is that there is no immediate problem, but you are checking to be sure.

Initially, many medical staffs reacted to this standard with the belief that it would require traditional proctoring by observation and wondered how they could possibly meet the standard.  However, the standard never really called for observational proctoring, only for a focused time of evaluation following the initial exercise of privileges and clear plan of how that would be accomplished. Although some medical staffs use concurrent evaluation, e.g. proctoring, most conduct retrospective evaluation by chart review.  Although this is clearly an additional burden that medical staffs did not have to meet before The Joint Commission implemented the FPPE standard, it is not nearly the scheduling and resource nightmare that was anticipated. 

So what has the impact of FPPE been over the past few years?  There is no question that concurrent observation is the better method to truly evaluate current competency, particularly for procedural skills. But from a practical sense, at least doing some form of evaluation in the first three to six months is a better safeguard than the pre-FPPE privileging process that relied solely on references and some limited external data. I believe that physicians generally feel that it is better to proactively obtain competency data once someone has started on your staff rather than wait for something bad to happen.

Although it has taken a while for medical staffs to get FPPE in place, my observations in working with hospital medical staffs is that it is beginning to take hold. I can’t say at this time how often FPPE uncovers an issue that would have otherwise gone unnoticed for a longer period of time. But if done in a practical manner, it is worth the effort to prevent an issue.

Robert Marder, MD, CMSL, is vice president of The Greeley Company, a division of HCPro, Inc. in Danvers, MA.

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