How can peer review culture change?

Oftentimes, medical staffs suffer from a punitive or indifferent peer review culture. The good news is that peer review culture can indeed change to one that supports physician improvement and the pursuit of excellence. However, although policies can change quickly, true culture change is slow, often taking several years depending on the size of the organization.

How do you get there? According to peer review expert Robert Marder, MD, there are three common keys to successful cultural change related to peer review:

1. The first key is looking at what we value and how we act. For example, do we claim to value data, yet whenever it is provided, the discussion immediately focuses on minor inaccuracies rather than broad patterns? Do we claim to value collegiality but send accusatory letters when inquiring about a case under review? Do we claim to value excellence, but have set no targets to recognize it in our OPPE reports? Linking your actions to your values is the key to an effective culture strategy. In particular for peer review, addressing potential biases is critical to defining and implementing these values.
2. A second key is recognizing that there is not a single organizational culture but that there are often many cultures or subcultures. Although the peer review culture is driven mainly by the general medical staff culture, there are often distinct physician subcultures. For example, the surgical peer review culture has traditionally been viewed as harsher than the medical culture. Stories of rough and tumble surgical morbidity and mortality (M&M) conferences are common based on the nature of surgical training programs (in fact, there is a saying that surgeons, like hamsters, often eat their young).
   Part of understanding organizational subcultures is acknowledging that to conduct peer review well, the medical staff needs to interface with other parts of the organization—such as quality management, risk management, and information technology—and those organizational subcultures. In redesigning medical staff peer review programs over the past 15 years, I have noted three particular subcultures that can have a strong impact on the success of your peer review program: case review support, risk management, and organizational performance improvement (PI) and patient safety. The information technology (IT) culture also plays an important role, but these other groups interface with IT to provide peer review services to the medical staff.
3. A third key is engaging strong physician leadership to drive the change management strategy. Unlike software that you download onto your computer, ideas that drive change do not implement themselves. As physician members question the new approaches, physician leaders must demonstrate resolve to help the medical staff stay the course.