Redesigning your peer review program

Since 2000, many hospitals have changed their peer review approach, with estimates that more than 50% now use the multispecialty model. Having assisted many organizations with this transformation, I wanted to find out whether these efforts were useful and sustainable. Through a structured interview with 10 such hospitals, I created a set of case studies to provide the first two components of the benchmark definition: a point of reference and a standard of excellence. The selected hospitals were ones that I had worked with to redesign their peer review programs. Each had created a multispecialty peer review structure focusing on a standardized case review process, the increased use of aggregate data to decrease reliance on case review, and the implementation of performance improvement–oriented practices to drive their peer review culture.

Each hospital also completed a structured self-assessment comprised of 50 criteria across six categories to address the third benchmarking definitional component: a test set for comparison.

Since the hospitals varied in size, location, and status (i.e., system vs independent), the challenges faced and the lessons learned might be applicable to some organizations, but not others. Here are a few examples:

• Multispecialty peer review can help enhance a transition to a positive peer review culture by increasing the sense of objectivity, fairness, and understanding among specialties of what constitutes excellent patient care
• As inpatient care changes, the committee needs to routinely evaluate its composition to ensure it has the appropriate expertise for the scope and complexity of the cases it receives
• Keeping focused on physician improvement and recognition of excellence is helpful for both the committee’s morale and the medical staff’s perception of the committee
• Sticking to your policies is a partnership between the quality staff who understands the policies and the physician leaders who respect their staff’s expertise
• Selecting an initial committee chair who is unbiased and able to control conversation or personal agendas is critical for early committee credibility and maintaining member interest
• Sending letters that aren’t only “bad news,” such as letters for appropriate or exemplary care, can change the medical staff’s perception of the committee’s role
• For multihospital systems, maintaining consistency of the peer review process among the individual hospital committees is critical in creating a common sense of fairness within the system
• A standardized FPPE improvement plan can help department chairs develop a more thorough plan

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Source: CRC News & Analysis