Tip of the week: Beware of ineffective peer review

Unfortunately, ineffective peer review can and does happen at hospitals across the country. An organization's ineffective peer review system may be brought to light by examining publicly reported performance measurements, successful lawsuits that are the results of poor physician performance, or the discovery that a physician on the medical staff is not performing up to par, yet no one in the organization is willing to address this behavior.

Regardless of the circumstances that brought attention to the organization's ineffective peer review system, the hospital must respond by analyzing its current process to identify areas to improve.

Here are some helpful tips:

• Analyze the process. Take a look at the performance expectations adopted by your medical staff. Also study whether the mechanism used by medical staff leaders to provide physicians with feedback regarding their performance is adequate.
• Eliminate bias. Ensure that measurements and targets are developed prospectively, assign a multispecialty committee rather than a departmental committee or the department chair to conduct chart review, and mandate that peer review committee members make any conflicts known to the committee.
• Ensure accuracy. Physicians may claim that the data used to carry out peer review is invalid. This is a claim that many medical staff leaders have heard. It is true that the discovery of even the slightest inaccuracy will invalidate the entire performance report. Physicians will assume, and no one would blame them, that if the report includes one inaccuracy it is likely that there are additional inaccuracies.
• Take action. Physician leaders have to step up to the plate to help mentor poorly performing physicians and take action to protect patients when the physician is unable or unwilling to improve.