Selecting members for your peer review committee

In January, many medical staffs have a change in leadership and subsequently a change in committee appointments. Although many medical staff leaders are simply grateful that any member of the medical staff is willing to serve on medical staff committees, good medical staff leaders try to appoint members to committees that will help the medical staff do its job effectively.

One of the key committees for many medical staffs is the peer review committee. This may either be a single committee for the entire medical staff whose members are appointed by the medical staff president, or several departmental committees whose members are appointed by either the medical staff president or department chair. When appointing committee members, leaders are typically guided by two main attributes:  clinical credibility and willingness to serve. Both are important. Without clinical credibility, the findings of the peer review committee might be ill-received by the medical staff members it is evaluating. Without willingness to serve, committees face delays in case reviews because of inadequate attendance.

However, given the importance of peer review in assuring quality of patient care, I'd like to suggest that there are three additional attributes for selecting peer review committee members that are also quite important:

·         Performance improvement focus

·         Respect for committee procedures and policies

·         Self-awareness for conflict of interest

Performance improvement focus means that although peer review will identify instances where physician care was less than appropriate, the primary focus is to help the physician improve the care in the future rather than determining the punishment for the past. This does not mean that peer review cannot lead to corrective action when warranted. But finding physicians for your committee whose first goal is to help physicians improve will create a receptive culture for the findings of the committee. In addition, it is easier for physicians to make determinations that the care is less than appropriate when they know that the outcome of that finding will be focused on improvement, not punishment.

Respect for committee policies and procedures means that the member is committed to perform his or her duties in the way that the medical staff has designed peer review. This is evidenced by:

·         Abiding by timelines for performing case reviews

·         Cooperating with the support staff

·         Being prepared to discuss cases

·         Maintaining confidentiality of discussions outside of the meeting

·         Following conflict of interest procedures

Self-awareness of conflict of interest goes beyond merely meeting the policies for conflict of interest; it means being aware of when potential conflicts may exist. Unfortunately, in many peer review committees, some members serve on the committee to preserve a group’s interests. When this occurs, the credibility of the committee’s findings is often suspect. It is the ethical obligation of the individual with a potential conflict to disclose that concern to the deliberative body. It is the responsibility of the deliberative body to determine if the conflict is substantial enough to preclude the individual's involvement. Having a good self-awareness of potential conflicts does not mean the individual must recluse him or herself from the case; it means giving the deliberative body the opportunity to assure that potential conflicts are handled well.

Finding members to serve on peer review committees can be a difficult task in this era where fewer physicians seem to have the time available to serve. As in any job search, finding the ideal person to meet the job description is not usually realistic. Still, keeping in mind the aforementioned attributes should help create a peer review committee that has a greater likelihood of success because its members already bring to the table most, if not all, of the attributes we desire for this important function.

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