Laundry lists vs. core privileging
Laundry lists – long the customary approach for physicians to request privileges and department chiefs to approve (or deny) these requested privileges – are being recognized now for the absence of objectivity and evidenced-based decision-making. With the constant advances in medical technology, equipment, best-practices, etc. the ability to keep lists current is overwhelming.  Lists often fail to correlate criteria necessary to be considered eligible and experienced for the privilege(s) sought.

Core privileging is recognized as the preferred, objective evaluation mechanism for delineation of privileges.  In its “Privileging Basics,”[1] hcPro reiterates:

This system of core privileging recognizes that the combination of the completion of an approved residency training program, recent direct or indirect experience, and references from physicians who have observed the applicant’s practice form the basis for determining competence. 

     A successful core privileging system should include:

•          predefined criteria for each privilege that outline specific education, training, and experience requirements;

•          descriptions of clinical privileges that are accurate, detailed, comprehensive, and specific; and

•          a system that is designed to avoid denials by clearly stating the minimum education, training, and experience needed to apply for specific clinical privileges.

Uniformity and equality again are the goals. Does each physician application receive the same attention and review as every other?  Within a specialty, are all physicians provided the same opportunity to apply for and receive (where experienced) permission to perform specific procedures? 

One last comment on Privileging forms (that applies to all forms utilized in the Credentialing process): 

All lines and spaces should be completed. Signatures of applicant and Department Chair/Medical Staff Officer, dates of application or review/authorization of privileges, etc. should be complete. A good rule of thumb… if there are lines or spaces in an application or form that are no longer being used, it’s best to eliminate these on future printings. Areas where information is requested but are left blank give the impression of carelessness and haste. Omissions and inconsistent completion of application packages may become the groundwork for allegations of negligent credentialing and potentially translate into questions and suspicions of negligent care within the institution itself.  If an area of a form has become obsolete, it’s best to remove it from future printings of the form.