Multi-disciplinary membership and participation in peer review

Deciding whether to have non-physicians, such as nurses, participate in peer review is a culture issue-although it is wise to consult with your legal counsel to make sure that having non-physicians participate in peer review does not jeopardize any peer review legal protection.

The main question when making this decision is whether the presence of non-physicians would inhibit candid discussion. Although that is often cited as the reason for preventing non-physician participation, in many instances it has the opposite effect: When no one else is in the room, physicians sometimes excuse activities that other disciplines might question. Allowing non-physician participation is therefore a way to reduce professional bias. Another benefit of non-physician participation is linkage with other disciplines when system or process issues are identified. A third benefit is that it increases credibility and trust in the peer review process.

For multi-disciplinary participation to work well, the following criteria must be met:

1. Only physicians should be permitted to vote on matters of physician performance.
2. Participation is a privilege granted by the medical staff. It is based on trust that the participant will maintain confidentiality and the independence of the process from management.
3. The number of non-physicians should be limited-physician discussion may become inhibited if they sense that they are being observed.

If these criteria can be met, I encourage non-physician participation in peer review.

That's all for this week!

All the best,

Rick Sheff, MD
Chair
The Greeley Company
http://www.greeley.com/seminars/