Peer Review Monthly: Amazing Grace

Today, my wife and I celebrate our 32nd wedding anniversary. The primary reason that our marriage has lasted this long, especially in light of my many flaws, can be attributed to my wife’s ability to demonstrate grace (she has many other wonderful attributes, but due to limitations of space, I will focus on just this one).

The best definition I have heard for grace is “unmerited favor.” It means having the ability to accept and, yes, even forgive, people despite their flaws. While a marriage starts with love, I believe it is sustained by grace.

What does this have to do with peer review, the topic of this monthly column? Well, it got me thinking about the similarities between a successful marriage and a successful medical staff peer review program. Despite all the technicalities of regulations and procedures, like marriage, peer review is a relationship marked by mutual accountability that can be approached punitively or with grace.

The key here is to start with the understanding that, as members of the medical staff, you are mutually accountable for the evaluation and improvement of the quality and safety of the care that you provide individually in the hospital setting. That’s what you agree to when you sign the bylaws and say “I do.”

Then, like in a marriage, we begin to realize and understand the expectations we have for each other. Some of these are clear upfront (e.g., “Don’t leave the seat up” or “Complete your medical records”). Some expectations evolve over time based on the changing world around us and our own changing needs and perspectives. Medical staffs have historically given physician competency a technical definition, but now we recognize that multiple competencies define an excellent physician, including skills in the areas of communication and system-based practice.

Ultimately, our medical staff relationship, like a marriage, is defined by our behaviors and our response to feedback, especially in light of changing expectations. In medical staff terms, we call this peer review. (I am not sure if there is a marriage term but anyone who has been married knows the process does happen). This is where grace comes in. How we give that feedback and help an individual understand and deal with their shortcomings can be done punitively or with some measure of grace, particularly if the individual is willing to listen and change.

Does this mean peer review should never lead to corrective action? Just as some marriages can’t work if one or both parties are unwilling to even try to meet the other’s expectations and needs, there are some medical staff members who are unwilling to recognize the need for improvement and must be dealt with in stricter terms that may result in ending the relationship. But before we get there, let’s be sure we extended as much grace as possible to keep the relationship whole. 

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