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Granting of Privileges Once the credentialing process is over, the committee must have a process of granting privileges. This may include allowing the healthcare professional to work with limited, full, or denied privileges.[10] Granting privileges specific to the healthcare worker’s training and experience is important. For example, a family doctor who joins the hospital should not be allowed to perform a repair of lacerations or insert central lines. The hospital must always consider the potential risks when generating privileges for newly credentialed healthcare workers. The granting of privileges should be regularly updated, and the privileged information should be available to other departments. For example, a general surgeon may call the operating room in the middle of the night wanting to perform an abdominal aortic aneurysm repair, a procedure usually done by the vascular surgeon, and the nurse may want to know if he or she has been granted privileges for this surgery. The emergency room may call to determine if a physician has admitting privileges. No matter the decision to grant or deny privileges to a healthcare worker, the information should be relayed in writing within a specific time frame. Further, this information should also be made available to all appropriate external or internal entities within the hospital. When privileges are denied, the healthcare institution should have a system for appeals for healthcare workers. Professional Practice Monitoring and Evaluation Once a healthcare worker has been credentialed and is granted privileges to practice medicine, most hospitals have developed a monitoring program or a proctoring period. This is vital for surgeons.[11] For example, a newly trained vascular surgeon must be proctored for 5 to 15 cases to determine his or her hand skills and assess his or her clinical competence and criteria for doing the surgery. To ensure that the proctoring is unbiased, the committee needs to develop guidelines which include the following: Identify what specific criteria will be proctored. Clinical skills, surgical technique How will proctoring be done, and for what period? Who will be in charge of the actual proctoring? Will the physician be given a warning of proctoring? In what circumstance would an external proctor be brought in?

Once a healthcare worker has been credentialed and is granted privileges to practice medicine, most hospitals have developed a monitoring program or a proctoring period. This is vital for surgeons.[11] For example, a newly trained vascular surgeon must be proctored for 5 to 15 cases to determine his or her hand skills and assess his or her clinical competence and criteria for doing the surgery. To ensure that the proctoring is unbiased, the committee needs to develop guidelines which include the following: Identify what specific criteria will be proctored. Clinical skills, surgical technique How will proctoring be done, and for what period? Who will be in charge of the actual proctoring? Will the physician be given a warning of proctoring? In what circumstance would an external proctor be brought in? What if the healthcare professional fails proctoring? Will the privileges be rescinded? Will they only be able to assist or work under supervision, and for how long? Performance Monitoring Methods Once a healthcare worker has been credentialed and his or her privileges are approved, the hospital must have established performance monitoring methods. This may be done with proctoring. The healthcare provider may be provided with potential cases and suggest treatment plans. This may be done verbally or by text. Another way to proctor is for a senior staff member to observe the healthcare provider perform a procedure or review the management of a patient in the clinic. Sometimes, only a retrospective chart review of the patient's medical records may be possible. This should be done randomly on all healthcare workers who look after patients to ensure that they comply with the format of writing medical notes, date each entry, check the laboratory parameters, and follow up on any abnormal results. External Review

Sometimes, only a retrospective chart review of the patient's medical records may be possible. This should be done randomly on all healthcare workers who look after patients to ensure that they comply with the format of writing medical notes, date each entry, check the laboratory parameters, and follow up on any abnormal results. External Review Many hospitals are turning to external reviews of their healthcare workers in selected cases. This allows for unbiased evaluations. For example, a second opinion is necessary when there is a perceived conflict of interest or a need for more objective disciplinary action. For example, a newly recruited cardiac surgeon would like to perform a relatively new procedure that has not been accepted in mainstream cardiac surgery. Still, the senior cardiac surgeon feels that the procedure is highly risky and the traditional surgery method is safer. Sometimes, a second opinion from another expert may be required to prevent animosity and chaos in the department. Furthermore, sometimes, a second opinion may also help determine the healthcare worker’s state of mind. A physician's behavior may be erratic, and he may not be performing up to par, but all his colleagues feel that something is wrong with him. The physician is then sent for an internal mental evaluation, which he later claims was biased. In such cases, an independent medical examination may provide benefits as it helps to get an unbiased opinion.[12] External reviews are also useful when the number of healthcare workers is small and no appropriate peer reviewer is available. It is also important to get an external review when the healthcare worker has appealed a decision or if litigation is likely. An external review is also helpful when the staff is experienced and relatively new.

Credentialing requires the effort of an interprofessional team. Typically, each hospital has a credentialing specialist who works for medical staff. The physician applies supporting documents to the credential specialist. The hospital conducts primary source verification. For primary source verification, the Hospital gathers information directly from sources like ECFMG, medical schools, residency training programs, state medical boards, etc.  The credentialing specialist brings reports to the hospital credentialing committee. The Credentialing Committee is usually composed of members elected from different departments to serve on the committee. When a physician has a malpractice claim or other negative facts, credential committee members discuss the application individually and make recommendations based on hospital needs and physician qualifications. If the application is clear from all sources, the credentialing committee approves the application. Typically, the credentialling committee meets every 1 to 3 months. The application is then forwarded to the medical executive committee meeting for review. The medical executive committee usually comprises the chiefs of different sections, the legal department, risk management, and administrative personnel. The hospital board of directors reviews the application only after the medical executive committee approves. The hospital board of directors gives final approval to grant privileges so the physician can work in the hospital.