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Background: The purpose of credentialing is to ensure that clinicians provide safe, high-quality health-care services in accordance with good practice and legal requirements. This review assessed the institutional credentialing processes and governance structures required to support credentialing processes at an institutional, regional or health-care system level. Methods: Searches of MEDLINE, EMBASE and PubMed were conducted. Additional grey literature searches were performed using the Google search engine and specific searches of government web sites were conducted. The inclusion criteria were developed a priori and standardized extraction of the information to appraise the research questions was conducted systematically. Results: A total of 33 white papers were included in this systematic literature review: 18 were published in Australia, 1 in New Zealand, 10 in the United Kingdom, 2 in the United States of America and 2 in Canada. Four key principles were common throughout all studies included in this review: clear lines of responsibility for the credentialing process and supportive governance structures, clear standards for credentialing, a culture of continuous improvement and evaluation of credentialing process outcomes. Conclusions: No data were available to evaluate the relationship between the credentialing process and the safety and quality of health-care services or patient outcomes; and capturing such data is difficult because of the numerous factors that affect the relationship between credentialing, patient outcomes, and the safety and quality of health-care services. Consequently, developing methods to measure the effectiveness of credentialing processes represents an area for further research. [ABSTRACT FROM AUTHOR]