How does your medical staff handle criticism?

I was recently discussing with some medical staff leaders why they think their peer review program is not very effective. Although there are a number of factors regarding their policies, procedures, and organizational structure that have affect the effectiveness of the peer review program, the biggest issue seems to be a culture in which many physicians have difficulty accepting criticism.

In this medical staff’s culture, when the medical staff leaders identify a problem, they often withhold criticism early on in the process. They don’t address the issue until the problem reaches a point where a physician's privileges or membership might be in jeopardy. Unfortunately, by handling problems this way, the medical staff loses the opportunity for early intervention.

Accepting feedback is not an issue as long as the feedback is positive. As a matter of fact, medical staff members thrive whenever data demonstrates that the hospital is a top performer or when the individual physicians are top performers. However, when information indicates otherwise, they have great difficulty accepting that data, whether it be aggregate data from a scorecard or profile or individual case review feedback where the care was rated less than appropriate.

We all recognize that getting negative feedback about our valued activities is uncomfortable. The physicians’ negative response to criticism can result from individual egos or a culture where criticism is viewed as impolite or even shaming. Whichever the cause, when the inability to acceptable criticism is the dominant view of the medical staff, it makes it very difficult to conduct reasonable peer review.

So how do you go about creating a culture where criticism is accepted and even welcomed? The key is in the concept of reframing the issue to the pursuit of excellence through early intervention. The reason for giving physicians feedback on either individual cases or on aggregate data every six to nine months through ongoing professional practice evaluation is so they have the opportunity to improve their practices before issues rise to level of significance that require greater intervention. This can be achieved by clearly stating the intent and the affect of feedback while communicating with physicians in a collegial way with constructive criticism early on.
Medical staffs can clarify the intent and affect of feedback by clearly defining the significance of the issue and using the right methods to deliver the message. For example, simple noncompliance with policies or practices can be handled through routine letters that do not become part of a physician’s file. Or for case review, establishing different thresholds for focused evaluation based on the level of concern can help keep the affect of the criticism in perspective.

How does your medical staff handle criticism? If you're peer review program is struggling, take a step back and see if providing constructive criticism is an important aspect of your culture. Then consider taking some positive steps to address it.

Robert J. Marder, MD, CMSL, is vice president of The Greeley Company, a division of HCPro, Inc., in Danvers, MA.