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OVERVIEW
Banyak tuntutan / gugatan di RS akhir-akhir ini, yang
pada intinya mempertanyakan kompetensi Dr.
Pada kenyataannya banyak Dr yang kompetensinya
memang patut dipertanyakan.
Banyak pendidikan dokter yang belum melaksanakan
competency based teaching.
Banyak Dr yang kurang memahami hak-hak pasien.
Banyak Dr bekerja diluar kompetensi & kewenangannya.
RS pada umumnya juga belum punya Simulator untuk

Perlu
peraturan
perundang-undangan yang mampu memelatih
kompetensi.
lindungi patient safety, doctor safety dan hospital safety !!!

KEWENANGAN
Kewenangan (privileges) adalah power yang
diberikan oleh suatu otoritas kepada orang
tertentu yang memiliki kompetensi tertentu
sesuai yang dibutuhkan untuk melaksanakan
suatu tindakan atau perbuatan tertentu.
LISENSI
Permit from government to do something or
some act. (STR & SIP merupakan pemberian
kewenangan oleh pemerintah / gov. agency).

CLINICAL PRIVILEGES
Kewenangan yang diberikan kepada dokter,
dokter gigi, perawat dan bidan oleh Direktur
RS atau Hospital Governing Board untuk
memberikan layanan klinik kepada pasien di
Rumah Sakit yang bersangkutan.
Pemberian kewenangan tsb secara umum
dibatasi hanya pada tenaga kesehatan yang
memiliki kompetensi, lisensi dan pengalaman yang sesuai dengan yang dibutuhkan RS.

LATAR BELAKANG
CLINICAL PRIVILEGES
Perlunya kebijakan Clinical Privilege
di RS dikarenakan masih adanya
ketidak-konsistenan pendidikan Dr di
berbagai institusi pendidikan Dr di
negara-negara maju sehingga RS perlu
menetapkan kebijakan clinical privilege
utk menunjang kebijakan patient safety.

EMERGENCY PRIVILEGES
Emergency privileges perlu diberikan kpd
setiap tenaga kesehatan ketika ada kondisi
emergensi di RS, tanpa dikaitkan dengan
tugas layanan reguler maupun statusnya.
TEMPORARY PRIVILEGES
Temporary privileges bisa diberikan kepada
tenaga kesehatan untuk memberikan layanan
kesehatan dalam waktu terbatas atau kepada
pasien spesifik.

KOMPETENSI
Maknanya:
The condition of being capable.
The capacity to perform task or role.
Aspek kompetensi yang harus dikuasai agar
bisa disebut kompeten (NSWMB, 1997):
1.
2.
3.

Medical knowledge --- menguasai ilmu.

Clinical skill --- punya ketrampilan klinik.
Clinical judgment --- mampu menentukan
kebijakan klinik.
4. Humanistic quality --- berkualitas humanis.

KEGUNAAN KOMPETENSI
Dengan menguasai ke-5 aspek kompetensi
maka Dr akan mampu melaksanakan tugas
peran (task and role) sebagai:
1. Medical expert --- ahli kedokteran.
2. Professional --- praktisi (pengobat).
3. Communicator --- komunikator.
4. Health advocate --- penasehat kesehatan.
5. Scholar --- ilmuwan (ingin selalu meneliti).
6. Collaborator --- berkolaborasi.
7. Manager --- memanaj kesehatan (termasuk

CREDENTIALING
Credentialing (assuring professional
competency) is an important part of the
hospital application process.
Credentialing demonstrates that doctor
qualified to perform the procedures the
doctor have requested.

CREDENTIALING
Credentialing usually requires documentation of proof of graduation, state licenses,
diagnostic and therapeutic certification, malpractice insurance, completion of continuing
education requirements, professional
experience, curriculum vitae, and other
similar documentation.
It is wise to gather these documents before
beginning the process.
Credentials will typically be reviewed at the
time of the request for staff membership.

PRIVILEGING
The process of applying for and obtaining
hospital privileges can be a long and
arduous one.
The number of committees and their
structure will vary from hospital to hospital.
Credentials and privileges are typically
reviewed by the medical staff and proceed
at a somewhat faster pace.
Remember that at any point in the process
the doctor may remove your application
from consideration.

METODE
PEMBERIAN CLINICAL PRIVILEGES
Ada banyak metoda pemberian Clinical Privilege.
Masing-masing metode punya kelebihan dan
kelemahan atau punya keuntungan dan kerugian.
Terdapat 4 metode pemberian CP, yaitu:
1. Laundry list method.
2. Categorical privilege delineation method.
3. Core privilege delineation method.
4. Combination approach.
RS perlu mengkaji metode mana yg paling sesuai.

LAUNDRY LIST METHOD

1. This method has been in use since the 1950s.
2. To address issues related to inconsistent education
and training of physicians.
3. It requires the facility to develop a list of all possible
procedures a provider may perform for a specific type
of specialty.
4. Advantages of this approach include the availability
of a provider specific listing of approved procedures.
5. This is especially helpful for the surgical specialties.
6. The disadvantages of using this type of system are in
the maintenance and updating of the procedure lists.

Check List Clinical Privilege

CATAGORICAL PRIVILEGES
1. This method delineates clinical privileges
in specific categories or levels of
privileges.
2. The categories can be defined in many
ways, such as by training and experience,
patient types or diseases, major treatment
areas and degree of complexity.
3. This approach works well for medical
specialties.

CORE PRIVILEGES
1. The concept of core privileges requires the medical
staff to identify those cognitive and procedural skills
that are part of the core competency of a given
specialty.
2. This allows any physician meeting the requirements for
education, training and experience to perform any and
all of the core privileges.
3. Special procedure privileges may be obtained by
documenting additional training, experience and competency for specific procedures requested.
4. Lists of specific diagnostic and invasive procedure
skills must be developed for each set of core privileges.

COMBINATION APPROACH
Components of any of the above methods
can be combined to create a clinical privilege
delineation method appropriate to a specific
facility.

THE ULTIMATE RESULT

The ultimate result of any method of clinical
privilege delineation is to insure the clinical
competency of the medical staff.
During the initial appointment process clinical competency validation is accomplished
by obtaining references related to requested
clinical privileges and by verifying education,
training and experience.

MENILAI KOMPETENSI
1.
2.
3.

Board certification.
Documentation of training and experience .
Physicians may gain this training through
supervised training programs.
4. Practitioner may also gain provisional privileges
allowing him or her to perform the procedure
under the supervision of another practitioner
skilled in the proce-dure (proctoring).

5. Data from some new procedures have shown

that the complication rate decreases significan tly
and competency increases significantly after a
certain number procedures are performed.
6. Guidelines for competency in new procedures or
treatment modalities must be developed on the
basis of a review of the literature and the techni cal aspects of the procedure.
Once the guidelines are successfully met by the
practitioner, full privileges are granted.
7. As new procedures and treatment modalities
develop, guidelines for clinical privileges must
also develop.

CREDENTIALING ASPECTS

1. Kompetensi Akademik:
a. kognitif; dan
b. psikomotor.
2. Kesehatan:
a. kesehatan fisik; dan
b. kesehatan mental.

IMPAIRED PHYSICIANS
The one is unable to practice medicine
with reasonable skill and safety to patiens
because of a physical or mental illness,
including deterioration through the aging
process or motor skill, or excessive use or
abuse or drugs.
Joint Commission Credentialing, Privileging,
Competency, and Peer Review, 2003

PEMBATASAN UMUR
1. Apa relevansinya?
2. Adakah korelasinya antara pertambahan
umur dengan penurunan kompetensi?
3. Apa tujuan dari pembatasan tersebut?
4. Bagaimana cara melakukan pembatasan
umur dokter?
5. Adakah pengecualian bagi umur tertentu?

CREDENTIALS REVIEW
1. Ensure that all information in included in the
packet for the credential committee and medical staff review.
2. Information in the packet includes quality
and peer review data to support the requested
clinical privileges.
3. Additional information is included to address
any red flags such as liability insurance
claims, discrepancies in information on the
reappointment form.

MASA BERLAKUNYA CP
Clinical privilege tidak bersifat permanen
sehingga CP dapat:
a. dipersempit;
b. diperluas, melalui permohonan yang
didukung oleh setifikat pendidikan atau
pelatihan tambahan; atau
c. dicabut karena Dr tidak menunjukkan
kompetensi (professional and ethical
performance) seperti yang diharapkan.
d. dicabut karena umur.

ASPEK HUKUM (1)

CP merupakan subject matter dari hukum
privat, tetapi tidak boleh menafikan subject
matter dari hukum publik (STR & SIP).
CP memberikan legitimasi untuk melakukan
layanan klinik di RS ybs.
CP tidak selalu harus identik dgn pedoman
kompetensi dari Kolegium.
Jika tidak setuju dengan CP dari Direktur,
maka dokter boleh memutuskan hubungan
kerja dengan RS ybs.

ASPEK HUKUM (2)

Jika Dr melakukan tindakan diluar CP maka
Dr harus bertanggung-gugat penuh terhadap
kerugian pasien yang diakibatkan oleh
kesalahan/kelalaian, walau status Dr sebagai
sub-ordinate.
Jika RS ceroboh dalam menetapkan clinical
privilege kepada Dr maka corporate liability
dapat diterapkan jika pasien mengalami kerugian akibat kesalahan/kelalaian Dr.

INITIAL CREDENTIALING
1. Licensure what type of license is required for the
specific privilege, MD, DO, PA, NP?
2. Staff Category should the specific privilege be
restricted to a specific category of medical staff: active,
consulting, courtesy?
3. Training what specific training is required to perform
each privilege specified?
This component includes education, medical, dental,
nursing, postgraduate residency, fellowship and in
what specialties?
Also included in this area could be the requirement of
specific focused training and education related to the
privilege such as a 10-hour course in the use of lasers.

4. Concurrent privileges. The standards must define

any concurrent privileges that the provider must
possess such as surgical privileges for open cases
in addition to laparoscopic procedures.
5. Board certification/recertification requirements.
Board certification indicates that an individual has
demonstrated an understanding of a basic body of
knowledge. If board certification is a requirement for
a specific clinical privilege, then the criteria should
also address the consequences of not maintaining
board certification.
6. Preceptorship the standards should address
whether or not a the specific clinical privilege may
be obtained by participating in a Preceptorship and
the qualifications of the preceptorship including
training methods.

7. Continuing medical education requirements should

be outlined for each specific clinical privilege for
which there is a requirement for CME.
8. Required number of cases the specific minimum
number requirement indicating the level of
experience required to obtain clinical privileges for
the requested procedure.
9. Reference letter - standards for privileges should
include a requirement for reference letters from
either the providers education program, or from the
hospital Department Chair. The reference letter
should assess the providers qualifications and
competency to perform the specific clinical
privileges requested.

10. Proctoring/provisional requirements. For facilities

with an adequate number of members on the
medical staff to provide direct observation of the
care provided, proctoring can provide good
information on the level of skill and expertise of the
provider.
10. Confirmation of a certain number of patients treated
with a specific condition within a specified period of
months.
10. Information from other facilities. If the request for
privileges is the initial request, information on
volume and competence must be obtained from the
pervious practice site. The standards should
address what information must be obtained from
the previous facility.

RECRECENTIALING
Collect data on at least the following areas:
1. Number of procedures performed.
2. Number and types of diagnoses managed.
3. Outcomes achieved (complication rates, mortality
rates, readmission rates).
4. Results of review of required functions such as
blood use, medication use, operative and invasive
procedure review, medical record completion
including legibility and timeliness and the results of
performance improvement activities.
5. Risk management information such as patient
complaints, compliments, malpractice activity.
6. Utilization review data such as length of stay, and
resource utilization.

CONSIST OF THE CREDENTIALS

REVIEW
1. Ensure that all information in included in the
packet for the credential committee and
medical staff review.
2. Information in the packet includes quality
and peer review data to support the
requested clinical privileges.
3. Additional information is included to address
any red flags such as liability insurance
claims, discrepancies in information on the
reappointment form.