Peer review monthly: A Christmas Carol

In A Christmas Carol by Charles Dickens, three ghosts show Ebenezer Scrooge his past and present and what his future will be if he continues to treat his fellow man poorly. Perhaps with the holidays approaching, medical staffs should evaluate their past and present approaches to peer review and determine where their futures may lead.

I have worked with numerous medical staffs during the past nine years to redesign peer review programs. Often, medical staffs conduct peer review with a negative, punitive approach that encourages physicians to adopt a “Bah, humbug” attitude. The Greeley Company advocates for a multi-specialty, positive approach that focuses on physician improvement.

The question I deal with is always the same as the one that Scrooge asked, “Is this fate sure or can the future be changed?” For Ebenezer, the answer to that question lay in his willingness to change his values and act in the true spirit of charity. For medical staffs, the answer lies in their willingness to help physicians improve rather than punish those who struggle to meet perquisite standards.

I have had the privilege to work with many medical staffs that, at first, seemed locked to their old ways of specialty–based, punitive peer review. Probably like Scrooge, they had come to a place that they never intended to go and did not like what the future held if they persisted in their ways. A punitive approach will undoubtedly drive physicians away from participating in the peer review process and cause it to fall low on the medical staff’s priority list.

So what did they decide to do? By moving to multi-specialty peer review that embraced the spirit of physician improvement, they changed their fate. I have spoken with several medical staff leaders over past month who have seen this transformation occur during the course of 2009. They reported that the physicians involved in the peer review process are energized and engaged in a way they hadn’t been before. Their committee discussions now are meaningful and useful to improving patient care, and they are dealing with issues that they never could address before, such as defining the opportunities to improve both individual and aggregate physician care. For example, one medical staff leader showed me a list of eight issues the peer review committee had identified in just six months. By addressing these issues, the committee could improve patient care by improving the institutions, such as the hospital system, the physicians depend on.

Unfortunately, I have also interacted with medical staffs that did not believe they could or would change. In some cases, although they changed their structure, they could not break away from their old culture and reverted to previous practices despite policies that would allow them to act differently. In other circumstances, they have yet to act.

As you ponder your peer review program for the coming year, consider the following question: Have you moved to a positive peer review culture or do you still respond to the need for effective peer review with a “Bah, humbug” attitude? If you respond as Scrooge once did, take your own trip with the three ghosts and see if you are ready for a new approach and new attitude in 2010.

Best wishes for the holidays and the coming year.

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