Performance

Recommendations

Info

Approach We agreed the following key deliverables in our approach with the Ministry to frame the work we would undertake to review existing processes for licensing, credentialing, privileging, physician performance monitoring and peer review in BC at the College, the Ministry, HAs and hospitals: Development of a project charter and work plan; Development of a Review Assessment Framework (RAF); Final report with summary of findings and advice; and Final report presentation to the Ministry Action Team. Given the time and resources available for this review, we agreed with the Ministry that we would focus our attention on the acute care sector and, in a more limited way, private Non-Hospital Medical Surgical Facilities (NHMSFs) in the Province. Specifically we agreed that we would not examine practices within other areas of the health care system such as community provision, mental health services or long-term care. Understanding this report The purpose of this report is to outline certain matters that came to our attention during our work and to offer our comments and suggestions for improvement for the Ministry’s consideration. These comments, by their nature, are critical, as they relate solely to opportunities for enhancement and do not address the many positive features of the Ministry’s current activities and undertakings. Our procedures consisted of inquiry, surveying, and analysis of information provided by the Ministry, the College and HAs. The Ministry approved the interview list and the extent of the other materials provided by project participants. Such work does not constitute an audit. Accordingly, we express no opinion on processes, other information or internal controls. The evidence that supports our suggestions for improvement has been gathered through completed questionnaires, interview feedback and other comments, explanations and information received during our work. We are not responsible for this evidence; the sole responsibility lying with those who provided us with information and those we interviewed or otherwise interacted with during this review. Our findings arise from our enquiries, although we can provide no assurance as to the day-to-day operation of either those procedures reviewed or issues relating to physician licensing, credentialing, privileging and performance management in general. KPMG assumes no responsibility for our findings and we have not attempted to establish whether the issues raised in the report are pervasive, commonplace or rare; the issues raised are merely those that occurred during the course of our interviews and other work. All procedures covered in this report are dependent for their effectiveness on the diligence and propriety of those responsible for operating them and are capable of being overridden by persons holding positions of authority and trust. Ministry of Health 4 Provincial Review of Physician Licensing, Credentialing, Privileging & <strong>Performance</strong> Management © 2012 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
We have not graded our suggestions for improvement and have not sought to emphasize their importance in any way. Our report has been factually checked by the Ministry and senior clinicians, as well as all members of the Ministry Action Team and VP Medicines, or equivalent, at all HAs. The Ministry is responsible for the decisions to implement any recommendations and for considering their impact. Implementation of these opportunities will require the Ministry to plan and test any changes to ensure that the Ministry will realize satisfactory results. Key observations Licensing The Provincial Physician Registry project being undertaken by the Ministry Action Team will assist in helping structure information on licensing and will make it easier for information on restrictions on physician licenses to be made more readily available across the healthcare system. We make the following key observations in respect of licensing: The College has a robust and sound system for processing applications to be licensed in BC; The Federation of State Medical Boards in the US has a universal database that contains information on any disciplinary procedure across the US since the 1960s. BC would benefit from a similar system across Canada that incorporates standardization of aspects of the Agreement on Internal Trade; and The UK system of revalidation requires all doctors to demonstrate their licenses are up to date and their ongoing fitness to practice through five years of appraisal data, continuing professional development and multisource feedback. A similar system would reduce risk in BC. Ministry of Health 5 Provincial Review of Physician Licensing, Credentialing, Privileging & <strong>Performance</strong> Management © 2012 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
Page 1 and 2: ADVISORY SERVICES British Columbia
Page 3 and 4: Table of Contents GLOSSARY OF ABBRE
Page 5 and 6: CHAPTER 6: OUR FINDINGS - CREDENTIA
Page 7 and 8: Glossary of Abbreviations Abbreviat
Page 9: Chapter 1: Executive Summary Backgr
Page 13 and 14: Performance Management The Provinci
Page 15 and 16: Executive accountability on HA Boar
Page 17 and 18: Enhancing the role of the College (
Page 19 and 20: Future State Centralization and sta
Page 21 and 22: Report structure This Chapter provi
Page 23 and 24: Terms of our engagement KPMG was co
Page 25 and 26: Development of the Review Assessmen
Page 27 and 28: Chapter 3: Roles of Key Organizatio
Page 29 and 30: Health Authorities and Denomination
Page 31 and 32: Chapter 4: The Ministry’s respons
Page 33 and 34: Provincial Credentialing & Privileg
Page 35 and 36: Chapter 5: Our Findings - Licensing
Page 37 and 38: Technology The College’s annual l
Page 39 and 40: Other Canadian Provinces The AIT wa
Page 41 and 42: Role of organizations It is widely
Page 43 and 44: Appendix D provides the responses p
Page 45 and 46: Those interviewed felt that it is i
Page 47 and 48: Joint Commission on Accreditation o
Page 49 and 50: Role of organizations Ministry of H
Page 51 and 52: Communication Issues around communi
Page 53 and 54: Process In discussing performance m
Page 55 and 56: Legislative changes to enhance comm
Page 57 and 58: Suggestions for Improvement Chapter
Page 59 and 60: Executive accountability on HA Boar
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Medical school participation in any
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Role of the College and HAs Stronge
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Suggestion for Improvement #22: On
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Clinical leadership Clinical leader
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This future state will be character
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Step 2 - Receipt of the application
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Credentialing and privileging The r
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Process for restricted activities i
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Figure 3-3. Application Process at
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We noted that the privileges being
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The process involves the following
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QA Committee: This Committee focuse
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Appendix B: Process Maps for Initia
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Ministry of Health 81 Provincial Re
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Appendix D: Credentialing Standards
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Appendix E: US Data Bank details Th
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Appendix F: Board Directives on Pee
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Appendix G: Review Assessment Frame
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Additional Areas of Inquiry for mee
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HA Meeting Participants: Vice Presi
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Hospitals Meeting Participants: Hos
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In another response, it was indicat
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Performance Management 1. Do you ha
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11. Are there any instances where i
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Many facilities report this informa
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7. Do you have any special performa
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