Performance

The Health Technology Assessment Committee has been created to review all non-drug health technologies that meet a cost threshold of $25,000 per patient or
$1 million across the Province. While the Committee’s Terms of Reference are still being developed, we have been advised that the Committee will provide
advice and recommendations to Leadership Council on proposed technologies in the context of existing clinical practice, taking into account economic, human
resource, regulatory, and ethical considerations. 30 However, it is yet to be determined how this Committee’s work will be aligned with processes at the Tariff
Committee for approving billing codes and HAs as it relates to privileging.
Conflict of interest in smaller facilities
The risk of conflicts of interest are greater within small hospitals where the same group of physicians act on the local Credentials Committee, the local MAC and
the body which deals with performance related issues. Our interviews highlighted organizations where these conflicts are both actual and/or perceived.
While HAs have largely regionalized the privileging process, our interviews found that these systems rely both on information from the local level (which may not
be forthcoming from small centres) and segregation of duties (that may not exist in whole or part). Wider networks may be required to ensure such segregation.
Process
The legal and regulatory review found that there is a lack of consistent Province-wide standards on the level
of rigor required during the reappointment process 31 . During our discussions, however, HA leaders noted
that it was expected that the Department Head meet with each physician upon re-appointment before
approving an application to discuss any performance issues, plans for the year, etc. While this expectation
exists, especially among Board members, it is widely acknowledged that these review meetings are not
occurring in some or many cases, depending on the organizations concerned. Some of the reasons offered
include:
Some departments are very large and a Department Head could not be expected to meet with
hundreds of physicians;
Department Heads are not given the tools or support to conduct the reviews effectively; and
There is a general view that the annual re-appointment process is not the most appropriate time to
deal with performance issues.
We found that in most cases the Department Heads review the files, check to see if any physicians were
changing the privileges requested, and then approve the application. In one hospital, we actually found that
the Department Heads receive a summary of the applications rather than the actual forms for approval.
Leading practice
Within the VCHA Community of Care (one of
the three communities of care within VCHA)
there is an important step which has been
added which ensures that the appropriate
due diligence is completed during reappointment.
The Senior Medical Director of
the Community of Care meets with each
Department Head to go through each
application in the Department and discuss
any issues raised during the interviews. This
extra step, which also exists at PHSA,
ensures that the Department Head has met
with each physician. The Senior Medical
Director’s approval of each application is
therefore required before it can be sent on to
the Credentials Committee.
30 Email correspondence received from Ministry of Health Stakeholder Relations and Transformation Branch of the Planning and Innovation Division. Received April 3, 2012.
31 Osborne Margo, 2012. Physician Regulation: Legal Framework. Page 8.
Ministry of Health 38
Provincial Review of Physician Licensing, Credentialing, Privileging & Performance Management
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