Peer review is an essential safeguard in hospitals, but bias and inefficiencies prevent it from fulfilling its desired role. A PubMed study showed that at least 18 percent of the variance in quality of care results from peer review, so healthcare professionals need to assess the areas of opportunity in their systems for the best care. Here are common pain points in the peer review process.
Reviews Are Seen As Punitive
Since so few physicians interact with the peer review process, its current role of root cause analysis and quality improvement falls short of stated goals. According to a study published in the National Library of Medicine, 65 percent of physicians surveyed viewed the peer review process as unhelpful, while 30 percent said they were unaware of the process entirely. Experienced clinical physician and author of the study, Dr. Husam Bader, told Medplace that the lack of visibility creates obstacles to the procedure.
We're lacking when it comes to evaluating the work without having to have a bad outcome. Peer review is a really strong source of feedback that doctors can take back and improve on their quality of work. But when it's only occurring when a bad outcome happens, that's when it feels punitive and doctors will become defensive.
Bader also points out that peer review in small health systems is susceptible to bias. For example, doctors that work shifts together may hesitate to critique their close colleagues or, conversely, may be unforgiving in a review of a competitor.
Former Risk Leader at Cherokee Regional Medical Center, Terri Schimmer, experienced the repercussions of this bias firsthand in her peer review system. Since Cherokee is a smaller facility, most of the reviewers knew each other. Schimmer told Medplace that this resulted in poorer quality reviews.
Being a small facility, we just struggled with getting good information, because these men and women work with each other and eat lunch together. So it was really hard to peer review each other because they just tended to be really soft. It wouldn't be uncommon for me to get one with no concerns.
Although large hospitals like Ascension create healthy review ecosystems, smaller facilities may struggle to replicate 'just-culture.' For example, Cherokee Regional Medical Center suffered from limited resources as a facility serving a population of under 5,000. As a result, the administration only requested reviews after adverse events. Former Cherokee Risk Leader Terri Schimmer told Medplace that their peer review process became inefficient.
Our go-to expert that we often used was given different job duties. So, as a result, it was really difficult to track down and get a response, let alone do a review. So, we relied heavily on internal review because external reviews wouldn't get our reports for four or five months. One facility never even billed us because it took so long to get the information back.
External Experts For A Better Peer Review Culture
External reviews had an advantageous side effect for Cherokee. Not only did Medplace vastly improve the review process, but staff felt more comfortable participating in review committee meetings over time. In addition, Schimmer said that physicians began to look forward to meetings since the regular external reviews dispelled the notion that the board was punitive. Rather than view an evaluation as a punishment, doctors saw them as opportunities to level up their care.
"Doctors can get defensive of reviews, but it got better as we went along. Now all our medical staff is part of the review committee. In the end, it results in better care because everybody takes something away from those meetings."