Newsletter

Peer Review Study Released

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 improvement.2

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.

References

1. Edwards MT. The Objective Impact of Clinical Peer Review on Hospital Quality and Safety. American journal of medical quality. 2010.

2. Edwards MT. Clinical peer review program self-evaluation for US hospitals. American journal of medical quality. 25(6):474-80.