Improving Quality Through Effective Peer Review Evaluations
Editor's note: This blog was written by Andrew Rowe, CEO of AllMed Healthcare Management, an independent review organization that provides external peer review services to hospital groups and ASCs.
Hospitals continue to find it challenging to evaluate the performance of their practitioners and improve the quality of the care they deliver. It is a problem that can be linked to a breakdown in the peer review process. The solution lies specifically in improving the manner in which hospital peer review committees operate.
Hospitals that do have well functioning peer review operations - and that are doing a good job of evaluating practitioners - recognize the importance of several key success factors. These include having peers reviewing peers, identifying and eliminating conflicts of interest and establishing effective administrative processes. The leaders of best-practices hospitals know that acknowledging these factors is essential to improving their physicians' performance, and will lead to better clinical outcomes and better service to their patient populations and communities.
But how is a hospital to know that its peer review evaluation process is ineffective or has broken down? Following are some of the most common indicators:
- Leadership not communicating expectations to medical staff and the peer review committee
- Too many peer review decisions viewed as arbitrary or punitive in nature
- Practitioner evaluations not being conducted in a timely or consistent manner
- Lack of available staff to conduct reviews
- Evidence of conflict of interest among peer review committee members and practitioners
Successfully dealing with these problems involves several key steps, beginning with leadership establishing performance expectations, and then working with medical staff to define core competencies expected in practitioners.
Next, it's best that peer review committees perform ongoing measurement and monitoring of practitioner performance, not just at times of re-appointment or in the case of sentinel events. A committee should investigate all deviations from performance expectations, using both data and case reviews to make competency decisions.
There also should be a commitment to focused evaluations that help practitioners understand and correct identified deficiencies. Triggers should be established for more focused evaluations, such as in the case of increased negative outcomes, improper treatments or disruptive practitioner behavior.
Written policies are important, in order to document the factors that can lead to conflict of interest (COI), and to guide peer review committee members in properly identifying it so leadership can effectively manage it. Also important is having well developed processes for external peer review, which leading hospitals utilize in sensitive situations or when internal peer review committees are unable to objectively evaluate cases.
Lastly, best-practices hospitals have an ongoing process for evaluating the performance of their peer review committee and processes, using a peer review scorecard. This can include a simple rating scale to identify a program's strengths and weaknesses and help in measuring progress.
Effective practitioner evaluation requires a tight connection between hospital leadership and the peer review process. Hospitals that ensure this connection avoid the consequences of medical errors, ensure that their practitioners are consistently performing to standards, and are recognized for continually delivering high-quality care.