Peer Review Monthly: Do you trust your peer review committee chair?

Many of us who grew up with television in the 1950s remember the game show called “Who do you trust?” The recent death of Walter Cronkite reminded that same generation of the seemingly lost ability to place our trust in a credible individual. I believe that the description of Cronkite as the most trusted man in America is accurate. When he closed his newscast with “And that’s the way it is,” we felt confident that he had provided us with an accurate portrait of the world we lived in. I would like to focus this month’s column on how to select a Cronkite-like peer review committee chair.

Trust is also a critical component of peer review. There are several aspects of trust that make this difficult process fair and useful. We need to trust our identifying and screening systems to select appropriate cases. We need to trust the initial physician reviewers to render objective opinions. We need to trust our peer review committees to have discussions that are free of conflicts of interest or hidden agendas. Finally, and perhaps most importantly, we need to trust the peer review committee chair.

What characteristics of Walter Cronkite would translate to a trustworthy peer review committee chair? The four that come to mind are integrity, accuracy, perspective, and devotion.

• Integrity seems obvious when it comes to trust. How can we trust the peer review process unless we know that the person in charge can put aside personal opinions to assure that everyone is treated fairly?
• Accuracy in peer review means being sure that you have all the facts. A peer review committee chair must guide committee discussions to assure no one is rushing into a judgment.
• Perspective provides a chair the ability to place an issue into an appropriate context. He or she may consider the gravity of the issue or how similar issues have been successfully handled in the past.
• Devotion means being committed to the peer review program. Just as Cronkite was devoted to gathering and reporting the news, a peer review chair needs to make this function as a priority.

Ideally, medical staffs look for these characteristics when selecting a peer review committee chair, but in our consulting work, The Greeley Company has found that the peer review committee chair selection process often falls short. Here are some practical suggestions on how you can apply each of these characteristics to this important task:

• Integrity: We recommend that the chief of staff appoint the peer review committee chair with MEC approval rather than the medical staff electing him or her. Integrity should not be a popularity contest. The position requires the respect of the medical staff based on past leadership activities, as well a clinical excellence.
• Accuracy: Look for individuals who exhibit leadership skills, have a track record of keeping a level head when faced with difficult political issues, and insist on having the facts before rendering an opinion. Physicians also exercise this trait when making good clinical judgments regarding complex cases.
• Perspective: The Greeley Company recommends that the peer review committee chair is not included in the line of succession to medical staff president. Otherwise, he or she never has the opportunity to serve on the peer review committee prior to chairing and he or she is prevented from staying on the committee long enough to gain adequate experience and have time to apply it. We also recommend that medical staffs require the chair to serve as a member of the committee for at least one year prior to becoming chair (If possible, they should serve for several years as a member if they are performing well in that that role).
• Devotion: Find a chair who is willing to receive training on how to conduct peer review. This is a sign that he or she takes this task seriously and wants to do the best job possible.

Your peer review chair may not be Walter Cronkite, but he or she should be one of the most trusted practitioners on your medical staff.

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