Increase in multispecialty peer review

Over the past 15 years, an increasing number of hospitals have adopted some form of multi-specialty peer review. Before discussing this shift, there is a need to distinguish between two terms that are sometimes confused: multi-specialty and multi-disciplinary. Multi-specialty means that voting committee members are physicians from various specialties. Multi-disciplinary means that voting members are from different disciplines (e.g., physician, nurse, physical therapist). Although multi-specialty peer review committees can greatly benefit from having a few nonvoting representatives from other disciplines to reduce professional bias, the model being discussed is multi-specialty peer review.

How prevalent in hospitals is multi-specialty peer review? Anecdotally, when I first started leading seminars on peer review for The Greeley Company in 2001, only about 10% of the attendees were using this model. By 2015, it was more than 70%. Although this is not meant to be a statistically accurate poll, it does reflect the significant shift toward this model, which I would estimate may represent in 40%–50% of hospitals today. In 2009, a survey of more than 1,800 physician hospital leaders by Edwards et al. reported that a multi-specialty process is the norm for peer review, and 27% note that it is used at least occasionally.

What has driven this change? First, as mentioned earlier, medical staffs were looking for ways to improve the efficiency of peer review by reducing the number of committees. Second, medical staff leaders were often frustrated by the variation in effectiveness of the department peer review committees. Third, as hospitalized patients became sicker with more complex needs, many medical staffs recognized that patient care requires greater collaboration among specialties, and department-based committees created a lack of resolution and delays in sending cases back and forth.

Who has driven this change? A number of consulting groups and individual consultants have worked with hospitals directly. In addition, many hospitals have implemented, or attempted to implement, some of this model through educational seminars and publications using variations on this model or by obtaining information from another hospital that has made this transition. The variability in design and implementation of the model tends to be greater when done through the internally directed approach rather than a consultant-led approach.

Multispecialty peer review has a number of advantages that address the common concerns of traditional specialty-based models, such as the following:

• Minimizes bias: Because this model is multi-specialty, there is less individual and specialty bias. It brings multiple perspectives to the table during the evaluation process instead of adding them after the fact via a second department review or appeal to an oversight committee.
• Improves efficiency: It reduces the number of physician participants required for peer review in an age with declining physician involvement in medical staff functions. It is also more efficient for support staff because they have fewer committees to support.
• Increases reliability: With fewer committees, there are fewer reviewers to train, and as they work together over time, they normalize the evaluation process and increase reliability. It also removes the issue of variability because there is only one committee.

Source: Peer Review Benchmarking