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Helping physicians see FPPE as a tool, not a weapon

Medical Staff Leader Connection, January 14, 2009

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In 2007, The Joint Commission gave hospital medical staffs a gift: a framework to measure quality and provide practitioners with feedback. The Joint Commission has defined the process, namely focused professional practice evaluation (FPPE), but allows hospitals to decide how that process is carried out. The upshot is that when providers fail to meet quality standards, FPPE creates a pathway by which hospitals can encourage improvement. Finally, medical staffs can systematically improve practice patterns, systems of care, and patient outcomes by collecting data and setting targets. 

For some organizations, this means moving medical staff quality oversight from a peer review process, which may be subject to manipulation, to a more evidence-based, data-driven platform. However, my idealistic hope that FPPE can help providers shift the medical staff culture to one that adopts a more robust quality process is tempered by physicians’ distrust of the “latest and greatest.” 

For physicians to mistrust a new medical staff process is not outlandish. Quality leaders in the past were accused of tarnishing reputations and threatening the livelihoods of their economic competitors and of engaging in witch hunts in the name of quality. “Victimized” physicians responded by lambasting their colleagues in legal battles.

Once specialty societies developed guidelines that evolved into national standards and evidence based medicine took the stage, it became possible to track and trend physician performance. The Centers for Medicare & Medicaid Services (CMS) accelerated the quality movement by developing national quality indicators for hospitals that address acute myocardial infarction, heart failure, pneumonia, and surgical care. In addition, the Institute for Healthcare Improvement (IHI) is currently driving quality from a systems perspective. Under such a model, patient care would no longer be a function of a single decision maker; rather, treatment plans would be determined by a team of providers. These changes have created a new practice environment in which physicians have no excuses for providing inadequate or inappropriate care.

Although I enthusiastically embrace FPPE as a solid process that is insulated from political agendas, it appears the old guard is distrustful given that the past is difficult to forget. Gaining their support will take time. Nonetheless, I feel that FPPE provides a wonderful tool to bring rogue physicians back into the fold of evidence-based medicine—cleanly, legally, with a well-defined process. 

By giving physicians feedback when their clinical performance does not meet defined standards and encouraging them to meet specific standards, we place quality on a new altar. It’s not about nailing outlying practitioners—it’s about negotiating with doctor’s to grow and learn, especially as practicing hospital-based medicine becomes more complex and multi-disciplinary care requires physicians to work in teams.

In this environment, identifying and abiding by best practices is a challenge for any physician.  Thanks to FPPE, hospitals can transform quality oversight from a police function into a positive pathway to building a culture of collaboration, quality, and safety. 

Carlotta Rinke, MD, FACP, MBA
Assistant vice president of quality and patient safety
Alexian Brothers Medical Center

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