Peer review is an essential safeguard in hospitals, but bias and inefficiencies prevent it from fulfilling its desired role. Here are 3 ways to avoid a biased peer review.
Although the U.S healthcare system and patients place immense trust in medical professionals, they are still human beings prone to error which is why unbiased peer reviews are essential to high-quality care. But like all professionals, specialists in the peer-review process have biases that impact the quality of reviews.
Many clinicians are speaking up and demanding more from peer review. For example, Dr. Husam Bader, an expert in clinical peer review and author of Clinical peer Review: A mandatory process with potential bias in desperate need of reform, discusses pitfalls in the process and possible solutions with Medplace CEO Jerrod Bailey in the Reimagining Healthcare – A New Dialogue with Risk & Patient Safety Leaders podcast. Here are the major takeaways from the conversation between Dr. Bader and Bailey.
The first step towards mitigating bias in the peer review process is being aware of potential types of biases from reviews. Several biases present obstacles to a fair assessment.
Hindsight and outcome bias happens when a reviewer is aware of the outcome of a case which influences the way they evaluate it. Because the events have already occurred, the causation seems evident to the reviewer, and they may feel as if they could have predicted the outcome. Dr. Bader compares this phenomenon to when an investor sees a stock they were interested in double and says, "I knew it!" But foresight, not hindsight, is the reality of clinical practice. Reviewers can only evaluate based on the clinician's process.
The relationship with the clinician in question also presents biases. Competitors may review harshly; close colleagues may deliver gentler reviews. Dr. Bader points out that reviewers may take a dramatically different approach to reviewing the case depending on their closeness.
If it's a colleague of yours, you probably don't want to give an unfavorable opinion. But if it's a competitor of yours, you might be a bit too harsh. So it goes both ways - We need the training and environment that would facilitate the person not to be biased.
Medical organizations can better understand how biases impact their case reviews by sending a fraction of the previous year’s cases with blinded outcomes through the peer-review process. Blinded peer review can reveal how cases with good results could have become dangerous. Most organizations only do peer reviews after a bad outcome, which harms their feedback culture. Peer reviews may seem punitive, leading to clinicians feeling defensive or even trying to hide potential mistakes. Blinded outcome reviews are one way to build a culture of honest, constructive feedback and protect from future bad outcomes.
To mitigate the biases created by relationships between reviews and reviewees, healthcare organizations can use remote/telehealth services to access reputable experts for peer review around the country. COVID-19 cemented the role of communications technology in the jobs of most medical professionals, and now healthcare organizations can easily go beyond their geographic location to enlist outside experts for peer review. For example, technologies such as Zoom or virtual expertise marketplaces like Medplace can offer unbiased external peer reviews and reviewer selection outside the limits of their staff.
Mayo Clinic illustrates how reviewers may introduce bias at many stages of the peer review process, making skewed results likely. According to their review titled, Peer Review Bias: A Critical Review, randomized trials that did not take steps to mitigate bias faced exaggerated odds ratios by up to 41 percent. Ultimately, health systems will need a mix of strategies to avoid biases in the admittedly flawed peer review process. Still, with the proper steps, they can avoid the major pitfalls.