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Overhauling the peer review system

Credentialing Resource Center Connection, June 24, 2005

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Dear credentialing colleague:

Imagine this scenario: This morning's newspaper brought you unfortunate news. The front-page story featured a physician on your medical staff who is allegedly responsible for numerous problematic patent outcomes that include misdiagnosis, complications, and mortalities. Your medical peer review committee has reviewed the physician's performance many times over the last two years. His records are regularly presented to the committee for its analysis and action. Unfortunately, the peer review committee has been extremely reluctant to recommend a formal investigation or corrective action to the medical executive committee. The physician is now the subject of a formal board of medical examiners' investigation. To your dismay, the records requested by the board for review are the same ones that were brought before your own peer review committee and deemed acceptable.

If you were to find yourself in this situation, it could mean that your peer review system is simply dead and no one knows it yet. Unfortunately, peer review committees often give the practitioner every benefit of the doubt. In these committees, patient protection is often secondary to physician protection.

Decades ago, this collegial attitude may have resulted in beneficial outcomes. Now, however, as a result of diminished peer review protection, a reluctance by many physicians to get involved, fear of legal reprisal, and a "who am I to judge" attitude, the peer review process is no longer an effective mechanism for patient protection and performance improvement. To fight this tendency, a full evaluation of the medical staff's peer review system is in order. In this particular scenario, it may be necessary to completely reorganize the way the institution and its medical staff leaders evaluate the performance of individual practitioners.

Although medical staff management and board members must implement systems designed to improve the quality of patient care, the institution and its staff leaders must also adopt systems that rapidly and effectively identify practitioners who require special assistance to practice at the recognized standard. Without this system, the very rational for an organized medical staff is in question.

That's it for this week.

All the best,
Hugh Greeley
http://www.greeley.com/seminars/

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