Designing an effective FPPE plan

Peer review continues to rate as a top challenge in healthcare organizations. Even if they are meeting regulatory standards, most organizations struggle to develop a peer review program that is meaningful to physicians. The following are best practices for creating an effective FPPE plan. Often physicians are asked to create an improvement plan without clear guidance as to what it should include. A poorly developed improvement plan is a disservice to both the physician under the FPPE and for the medical staff when trying to evaluate the results. To be effective, improvement plans need to begin with the end in mind by providing clear measurable goals and a method for obtaining the data needed to evaluate its success. The principles are the same as any standard quality improvement method. Outlined below is an example of the elements of a good FPPE plan:

• Improvement action: What will the physician do differently based on the improvement opportunity defined by the OPPE data?
• Improvement goal/milestones: What degree of change is expected in the data overall and, if appropriate, what interim milestones will demonstrate that the improvement has begun and is progressing?
• Time frames for achieving goal/milestones: When are the goal and any interim milestones expected to be achieved?
• Method of monitoring: Is monitoring the OPPE data sufficient or will additional data collection specific to the improvement opportunity be needed to demonstrate improvement?
• Next steps if goals are not achieved: What will be the anticipated consequences for the physician if the FPPE goal is not met?

The last component is one that is often avoided by physician leaders who wish to be collegial and feel that describing consequences this early in the process would be detrimental to that value. However, not including this element is actually unfair to the physician and creates political gridlock when the physician cries out to the medical staff, “You never told me that it would come to this!” The consequences at this stage do not have to be precise but can provide more of a general guidance such as a second round of monitoring, shortened or conditional renewal of privileges, or request to the MEC to consider formal action.

Source: Effective Peer Review: The Complete Guide to Physician Performance Improvement by Robert J. Marder, MD.