Many of the points raised by Dr Wade are well made, but his analysis does not reflect progress made over the last 2 years in response to these concerns. A review of progress implementing the recommendations from the Cochrane Report (2011) was carried out by the Physician Specialist Services Advisory Committee in 2014. Following this, further work on the Cochrane recommendations was brought under the BC Medical Quality Initiative (BC MQI). This included deployment of the CACTUS software component of the provincial credentialing and privileging project, completed at the end of 2015 and used by most health authorities for the first time during the 2016 privileging cycle. BC MQI also acts as holder of the BC Credentialing and Privileging Dictionaries. All the dictionaries can be accessed from the BC MQI website (http://bcmqi.ca), and requests for changes to dictionaries can also be submitted through the site. We have sought to make as much information as possible available through the site.
The first review of the dictionaries is currently underway, overseen by a BC MQI Privileging Dictionary Advisory Committee. This is ably chaired by Dr Becky Temple from Northern Health and the Medical Directors of BC Network. This exercise was informed by a prioritization study to determine which dictionaries were most urgently in need of review. The schedule for review and refresh can be found at http://bcmqi.ca/privileging-dictionaries/review-and-refresh-cycle-1. Additional information on the dictionaries and the credentialing and privileging process can be found in the BC MQI newsletters, available at http://bcmqi.ca/news. These can also be requested for delivery by e-mail.
We share Dr Wade’s concerns about burgeoning bureaucracy, and the intention is to streamline processes as far as possible. Currently each health authority has somewhat different processes, although all use CACTUS. Credentialing information is loaded by the Medical Affairs departments in the relevant health authority, and once this process is complete and the information has been uploaded to CACTUS then it should populate future applications. If this has not happened, it is usually due to a delay in uploading, and in this case the applicant is advised to wait for a day or so and then try again.
Credentialing is a process that could be done once, provincially, and there is a business case in preparation to allow us to do just that. This has been developed particularly in light of feedback such as that expressed by Dr Wade. This would also facilitate the sharing of documents with the College. A physician doing locums at different sites will have multiple privileging applications, but the credentials should need assembling only once. Privileging is always done in the context of work at a particular facility. We also recognize the burden of data collection, particularly for generalists working in rural and remote locations. BC MQI is working on how this can be reduced or made more manageable. It should be noted that the purpose of the privileging conversation, between a physician and their medical leader, is not to restrict practice but to ascertain what additional supports (training, simulation experience, etc.) may be required to maintain currency in the context of service requirements. Where collection of data is an issue, this should be raised in that conversation.
—Martin C. Wale, BM BS, FRCPath, MBA,
CCPE Executive Medical Lead, BC Medical Quality Initiative
—Becky Temple, MD, CCFP, CCPE
Medical Lead, Privileging Dictionary Review, BC Medical Quality Initiative
—Bev Mitchell, MSN, RN
Provincial Director, BC Medical Quality Initiative
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