Consistent and constructive peer review in hospitalist groups is not common. In fact, most groups only trigger peer review when a sentinel event arises. In my experience leading hundreds of hospitalists, I consistently find defensive behavior or—at the very least—avoidance of the peer review process. Clinicians view peer review as a punishment and unwelcome spotlight on shortcomings. It does not have to be that way. Peer review, when done right, has the power to improve patient care, boost service quality, and decrease the frequency of sentinel events.
Instead of viewing peer review as an inconvenience, what if we make it part of a culture of continuous improvement? Rather than considering it an unwanted disruption, what if we embrace it as a part of our regular education and quality improvement efforts? Shaping how a hospitalist team views peer review starts with the way the medical director and hospital leadership approach it.
Peer review is not a personal attack, instead it is educational and beneficial to patients. Additionally, it is confidential and not discoverable legally, protecting the physicians under review. Hospitalist leaders have an opportunity to make peer review a regular part of the culture of the program by designing a system to support it and communicating the value that program will present to the patient, provider, program, and hospital.
By putting a structure in place to support peer review and focusing on its collective value, the culture surrounding peer review in a hospitalist group can shift from subjective and confrontational to educational and collaborative, ultimately increasing patient safety and overall quality of care. Below are four key ways I suggest hospitalist leaders shift their team’s take on peer review:
1. Design a regular peer review process of all providers.
A regular peer review process is central to changing the culture of a hospitalist team’s peer review process. An anonymous survey that allows team members and leaders alike to give their colleagues anonymous constructive feedback is a great first step. This survey should center on your unique priorities, which may include efficiency, communication with colleagues and patients, documentation, engagement in meetings, quality measures, or other specific improvement initiatives.
2. Establish and support your peer review committee.
In addition to more general surveys on team member performance, it is also important to establish a formal group to perform peer review. Common hurdles associated with this include: fear of ramifications for criticizing friends and increased workload in an already busy practice. These hurdles can be overcome by focusing the team on the collective educational benefit and improved patient outcomes. Furthermore, clearly defining committee member rolls and providing committee training on peer review best practices ensures a consistent, timely, and objective process.
3. Do not wait for sentinel events, schedule regular review meetings.
Rather than conducting peer review as-needed, build it into your ongoing quality improvement efforts. For example, set up a quarterly meeting to review findings from the anonymous colleague survey and monthly meetings to discuss randomly selected charts or cases as a group. A consistent schedule ensures no provider feels singled out and all providers benefit and learn from the discussion.
4. Establish guidelines/resources for physicians who receive a peer review letter.
As part of these regular review meetings, also educate team members on what to expect and best practices for response in order to make the process as valuable as possible. Simply communicating the value of the findings of the review can be enough to encourage a provider not to ignore a peer review letter and to respond positively rather than angrily or defensively. Additionally, make the timeline expectations clear to providers (i.e. when is a response expected, and when they can expect a response from the peer review committee). It is also helpful to provide the physician a resource to proofread their response and manage the process, so they are not surprised by a letter or a negative conclusion when it comes time for hospital reappointment.
By making regular anonymous feedback and peer review part of the culture of your hospitalist program, you soften the impact of one-off peer review letters associated with sentinel events. Over time, hospitalists will consider peer review of their work an indispensable part of their continuing education efforts and the continuous improvement of patient care.