The governing board of every healthcare organization has a fiduciary duty to provide the patients it serves with safe and competent care. One of the strongest mechanisms for ensuring quality is rigorous credentialing of the practitioners who will provide care in the institution.

It is the board’s responsibility to grant membership and privileges to practitioners on staff, and it must hold members of management and the medical staff accountable for carefully assessing the credentials of applicants. The rapid development of new integrated delivery systems in this age of “accountable care” is creating new challenges for boards as they provide oversight of credentialing and privileging. This article will review current and evolving challenges to healthcare institutions posed by growing demands for the rigorous vetting of practitioner competence in a changing healthcare world.