The final results of the 2009 American College of Physician
Executives’ Peer Review Outcomes Study, just released online by
the American Journal of Medical Quality, show that when doctors
do clinical peer review using new methods, hospitalized patients
benefit from safer care.1
They also show that few are using these methods. It seems to be a
problem of inertia. Although the required changes are both
desirable and relatively easy, physicians are struggling against
a 30-year legacy of dysfunctional practice. There is great value
in dealing with this. The potential impact can be compared to the
IHI 100,000 Lives campaign.
In the new model, physicians evaluate each other’s performance
using the same Quality Improvement (QI) principles that have
served well elsewhere in medicine and in other fields. You know
that medical care is complex. It requires coordination of many
professional disciplines and lots of information. This system of
care is itself the source of many errors. The (QI) Model
recognizes this. When clinical peer review focuses on learning
from mistakes instead of casting blame, problems get fixed.
There are resources in the public domain to assist you and other
leaders with program changes including a self-evaluation tool
available at QAtoQI.com/set.htm. A second
article published in the November/December issue of the
American Journal of Medical Quality attests to the
validity of this tool and offers practical recommendations for
The old QA method of clinical peer review is a narrow extension
of the activity that hospitals are required to perform to assure
they have a competent medical staff. It focuses only on the
physician and ignores the system. It is perceived as threatening.
Doctors don’t become incompetent overnight unless they have a
major health event like a stroke that is obvious to everyone.
Good physicians can have bad outcomes, often from circumstances
beyond their immediate control. It’s not helpful to cast blame.
1. Edwards MT. The Objective Impact of Clinical Peer Review on
Hospital Quality and Safety. American journal of medical
2. Edwards MT. Clinical peer review program self-evaluation for
US hospitals. American journal of medical quality.
Dr. Edwards has more than 20 years of healthcare management and
consulting experience, including service as the senior physician
executive in both teaching and community hospitals. He is
the foremost authority on best practices in clinical peer review
having conducted 3 national studies and published 7 related
articles. He helps hospitals improve quality, safety, and
resource use and operates a Federally-listed Patient Safety