2012: Hurdling and hurling

It is generally accepted that physician medical error is a result of a system failure. Physician errors can be attributed to a number of factors including equipment failures or unfamiliarity, time pressures, distractions, training deficiencies, or simply not knowing what we don’t know.

The recent investigation into the CT misreads by four radiologists might seem remote for most of our clinical practices. But don’t be deceived. Not infrequently we perform clinical act­ivities that result in a mistake or near mistake that under the wrong circumstance can result in patient harm. However, these clinical activities do not often leave the same permanent footprint as a diagnostic imaging misread. 

It therefore comes as no surprise that the recent report compiled by Dr Doug Cochrane, chair of the Patient Safety and Quality Council, made recommendations that go far beyond the world of diagnostic imaging and will impose some serious hurdles for all physicians. 

Reviewing the 35 recommendations contained in the report is beyond the scope of this editorial. Instead, let me define a number of terms contained in the report that are important for you to know and are frequently misunderstood.

Licensing
The granting of permission to practise medicine, which is done by each pro­vincial College and is subject to meeting training certification requirements (MD, LMCC, and CCFP or FRCP).

Credentialing
The process of evaluating the training, experience, and competence of physicians qualified to provide certain discipline services or procedures usually extra to requirements for licen­sing. For example, pulmonary function testing, electrodiagnostics, and CT colonography are skills usually obtained beyond the requirements for licensing. 

Privileging
The process of granting privileges as permits to undertake specified clinical activities once licensing and credentialing requirements have been met. Physicians can only be given privileges for activities for which they have necessary credentials and may be de­nied privileges for lack of resources or need. For example, a cardiologist may be unable to perform interventional cardiology in a rural hospital even if he or she has the appropriate credentials.

Revalidation
The process of repeat validation of medical licensure by demonstrating competence. Revalidation requirements are evolving but, in future, will be more than providing evidence of CME.

Peer review
A proactive periodic review of clinical activities by peers for the purpose of education and improvement not 
in response to complaints or clinical concerns. This activity is normally highly confidential so as to promote full cooperation with the process.

Performance assessment
An ongoing evaluation of a physician’s work quality, objectives, contributions, and compliance with regulations. For example, hospital departmental requirements may require attendance at M & M rounds, have requirements for minimum number of procedures, participation in research, and satisfactory resolution of complaints. Performance reviews usually occur in conjunction with hospital staff re-appointments.

Multi-source feedback (a.k.a. physician achievement reviews or 360° reviews)
The process of providing feedback to physicians by patients, colleagues, and health care staff. The questionnaires can be designed to capture a range of competencies including communication, professional responsibility, professional development, and patient interaction.

Accreditation
A process for ensuring compliance of facilities, hospitals, or other organizations (not physicians) with preset and agreed-upon standards. In order for a facility to be accredited it may have to show compliance with medical staff performance management. 

Given these definitions, I will leave it up to you to connect the dots as to where the health authorities, Ministry of Health, and College are heading to comply with the Cochrane recommendations.

You probably thought I was referring to your possible emetic response to these recommendations in the title of this editorial. Far from it, hurling is the national sport of Ireland and only a sporting attitude will get us through the challenges that are about to unfold.
—WRV