OPPE and FPPE: Tools to help make privileging decisions | Joint Commission

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High Reliability Healthcare

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Observations and Lessons Learned on the Journey to High Reliability Health Care.

OPPE and FPPE: Tools to help make privileging decisions

Aug 21, 2013 | 97313 Views

By Robert A. Wise, M.D.
Medical Advisor
The Joint Commission

Since the continuation of clinicians’ privileges at a hospital hinges on the quality and safety of care delivered to patients, the review of privileges is a critical – and sensitive – process. This responsibility falls on the medical staff, which monitors the performance of all practitioners who are granted privileges and makes recommendations to the governing body of the hospital concerning which medical staff members should receive new or maintain existing privileges. 

In order to make the decision of privileging more objective and continuous, in 2007 The Joint Commission introduced its Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) processes. These tools were created to work together to help determine if the care delivered by a practitioner falls below an acceptable level of performance. It is important to note that neither tool on its own is capable of making an adequate assessment, but instead it is the thoughtful and judicious use of both that is required. The following is an explanation of these two tools.

  • OPPE is a screening tool to evaluate all practitioners who have been granted privileges and to identify those clinicians who might be delivering an unacceptable quality of care. It is important to emphasize that OPPE is not designed to identify clinicians who are delivering good or excellent care. Therefore, the criteria used for OPPE may also identify some clinicians who have no quality of care issues (i.e., identification of situations that turn out to be false positives). As with all screening tests, a positive finding must be followed up with a more specific diagnostic test, one that should have high specificity for poor care.
  • FPPE is the follow up process to determine the validity of any positives (whether true or false) found through OPPE. This process is applied only to the small number of clinicians who were identified by OPPE.

Since the outcome of the FPPE is so important, the review, decision and follow-up process developed by the hospital – usually at the department level – must be objective and capable of accurately determining when a clinician’s performance is falling below an acceptable norm. To accomplish this goal, it is important that a thorough and thoughtful process be developed by each department with substantial input from peers.  

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Comments (1 Comments)

Scott Tromanhauser - Boston, MA
What is the best approach to no or low volume medical staff members when it comes to OPPE? When they come up for re-appointment and there is no data because they haven't used the facility, what do we use to evaluate their quality and performance?
10:10 AM Jun 9th