Medical Staff governance: Process for credentialing and privileging

In the complex world of health care, ensuring that practitioners are well-qualified and capable of providing safe, high-quality care is paramount. Two key processes that play a critical role in this are credentialing and privileging. While these terms are sometimes used interchangeably, they refer to distinct processes, each with its unique purpose and procedure.

Credentialing is the process of verifying the qualifications and background of health care professionals, usually referred to as primary source verification (PSV). PSV, per The Joint Commission, must be obtained from approved and verified sources, such as the American Board of Medical Specialties (ABMS). This process ensures that the practitioners have the necessary education, training, and experience to provide care. Credentialing typically involves a comprehensive review of the following elements:

·       Education and Training: Verification of degrees, certifications, and other educational achievements from accredited institutions.

·       Licensing: Confirmation that the practitioner holds a valid, up-to-date license to practice in their specific field and geographic location.

·       Work History: Review of previous employment and professional experience to ensure relevant and sufficient practice.

·       Board Certification: Verification of specialty board certification, if applicable, to ensure the practitioner has met rigorous standards in their specialty.

·       Background Checks: Comprehensive background checks to identify any history of malpractice, disciplinary actions, or criminal activity.

·       References: Obtaining references from peers, mentors, or employers to attest to the practitioner's competence and character.

In South Puget Sound, Medical Staff coordinators, guided by the Credentialing supervisor, use MD-Staff software to manage credentialing. Since its implementation in fall 2024, MD-Staff has streamlined processes and reduced application times, helping onboard qualified professionals who will maintain our high standards for patient safety.

Privileging, on the other hand, is the process of authorizing a physician or advanced practice clinician (APC) to perform specific procedures or services at Providence Centralia or Providence St. Peter. This process goes beyond credentialing by focusing on the physician or APC's current competence and skills in relation to the services they will provide. Privileging involves the following steps:

·       Application: The practitioner must submit an application and privilege request form via MD-Staff detailing the specific procedures or services they wish to perform.

·       Assessment: Verification of and direct assessment of the practitioner's skills and knowledge through peer evaluations, procedure/case reviews, or proctoring.

·       Review: Departmental Committee Chairs review all initial and reappointment applications. The Credentials & Bylaws Committee at Centralia and Credentials Committee at St. Peter reviews the practitioner's qualifications, experience, and current competence in the requested areas.

·       Approval: The Medical Executive Committee approves privileges based on the practitioner's competence and Centralia and St. Peter’s needs. The South Puget Sound Community Mission Board has the final approval to grant privileges.

·       Ongoing Monitoring: Regular evaluation of each practitioner's performance and outcomes to ensure continued competence and quality of care.

Privileging is specific to each facility and is directly linked to the resources, equipment, and support services available. It ensures practitioners are not only qualified but also capable of performing the procedures safely and effectively within the specific context of the facility.

While credentialing and privileging are both essential for ensuring the quality and safety of healthcare, they differ in several key ways:

·       Scope: Credentialing is a broad, general process that verifies a practitioner's overall qualifications and background. Privileging is specific to the services a practitioner is authorized to perform within a particular facility.

·       Focus: Credentialing focuses on the practitioner's education, training, and licensure history. Privileging emphasizes the practitioner's current competency and ability to perform specific procedures.

·       Process: Credentialing involves verifying documents, licensure, and references. Privileging includes direct assessment, peer reviews, and ongoing monitoring of performance.

·       Purpose: Credentialing ensures that practitioners meet basic standards for practice. Privileging ensures that practitioners can safely and effectively perform specific procedures at Centralia or St. Peter.

Both credentialing and privileging are critical to maintaining high standards of care in health care settings. Credentialing provides the foundation by verifying that practitioners have the necessary qualifications and background. Privileging builds on this foundation, ensuring that practitioners possess the specific skills and competence required to deliver safe and effective care in their respective roles. Together, these processes help protect patients and practitioners, enhance the quality of care, and uphold the integrity of the health care profession.