Accurately Evaluate Provider Performance

The Joint Commission announced the requirement for OPPE in 2007, in order to give organizations time to formulate their strategies for compliance by January 1, 2008 (the date on which OPPE requirements became effective). We are now in our 10th year of being required to have an OPPE process in place.

What have we learned during the last 10 years?

1. OPPE is a component of privileging. The reason requiring OPPE is to compel organizations to use data to evaluate provider competency specifically related to the exercise of clinical privileges.

2. Performance reports must be focused on the privileges that are granted - therefore, they must be specialty-specific.

3. More comprehensive clinical activity reports are necessary in order to evaluate a provider's activity within an organization. It is insufficient to just identify numbers of admissions/discharges, consultations and total number of procedures.  This does not meet Joint Commission requirements.  It is necessary to collect numbers on the types of procedures performed, etc. Matching procedures performed to privileges granted is essential.

4. The definition of competency has forever been expanded to include more than technical expertise. We now include other factors in evaluation of competency - such as professionalism, interpersonal and communication skills, etc. Organizations are now incorporating information about a provider's ability to work well with all caregivers and communication with patients into OPPE reports.

5. Organizations are better served to start small and build on a solid foundation rather than to try to include too much data on reports. A Joint Commission finding has been that some organizations put a robust policy and procedure in place and then are unable to meet their own requirements.

6. Collaboration from the Medical Staff Office and Quality Management Department is essential to support the process of implementation of meaningful performance reports.

7. Organizations either need to establish thresholds or targets - or analyze each and every performance report in order to identify data that is out of the norm. It is much less work in the long run to establish targets.

8. OPPE is applicable to any provider granted clinical privileges, including physician assistants and advanced practice registered nurses. OPPE data can be difficult - but not impossible - to collect for these providers. In many cases, data is difficult to collect because of how the organization decided to implement the electronic patient record (i.e., defaults to attending/admitting provider rather than to the provider - such as a nurse provider - who provided the care/service).

9. Sometimes it is not feasible to attribute data to a specific provider - the data is more relevant to a team or group.  Astute organizations are working to develop and use team data. This is also relevant to some privileges that are team procedures rather than a provider-specific privilege. Stay tuned for more information as this continues to evolve.

10. An indicator data dictionary is needed in order to define each indicator that is used in OPPE reports. For example - an indicator such as "unexpected death" must be defined so that all users/participants in the process of OPPE would know what data would be consistently included.

11. Most organizations are sharing performance information with their providers. In order for providers to improve performance, they need to know how their performance varies from their peers.

12. Organizations that contract/employ providers want to use the same reports for performance evaluations for "HR" and privileging/OPPE. This dual usage requires that great care be taken related to how reports are generated, used and maintained to avoid discoverability issues.

Many more lessons have been learned during the past 10 years - and it is certain that organizations will continue to learn how to conduct effective provider performance evaluation.

I'd love to hear from organizations that have OPPE success stories to share.