This week's problem is addressed by Jon Moses, MHA. Mr. Moses is President and CEO of MDReview which he co-founded. He is a former hospital CEO with over 25 years senior hospital leadership experience.
Problem:
"Our medical staff leadership debates if and when to notify a physician that one or more of his/her cases are under peer review. What is the right approach?"
Solution:
We have seen a wide variety of strategies employed by
hospitals in this regard. Before
addressing this question, let me be clear that the following solution addresses
cases of focused professional practice evaluation, specifically cases selected
for peer review as a result of some identified concern. For such cases, we have observed a full range
of approaches from early and full disclosure, to disclosure only if the medical
staff reaches a conclusion that impacts the physician or requires action. What is the right approach?
Perhaps the better question is: "What is the right thing to do?" This question is best answered by determining
how members of the medical staff would want to be treated if their cases or
practice came under focused evaluation. I
doubt that many physicians look kindly upon having their clinical care assessed
by their peers, especially in the face of clinical concerns, without being made
fully aware of and, to the extent possible, involved in the process. Most want to know up front and appreciate the
opportunity to be engaged in the process in a collegial fashion. The right thing to do is to notify the
physician at the earliest possible time and, where possible, to engage the
physician in the process.
Failure to notify or involve the physician under review jeopardizes trust. And trust is the foundation of any high
functioning peer review program. When
the norm is to conduct business behind the backs of those most affected,
potential short term gains will be overshadowed by longer term deterioration. As relationships are threatened on a case by
case basis, peer review becomes less productive and far more difficult. In many cases, peer review comes to be avoided
despite the great potential it holds as a quality management tool.
A common reason given for not involving physicians in peer review is that some
can become defensive, unpleasant and downright obstructive. While this may be true, it is not the norm. If we treat others according to the Golden
Rule, reciprocation is likely and respect is given and received by all
involved. It makes little sense to treat
all physicians in a manner other than how we would want to be treated simply
out of concern for how the minority might respond.
Leaders, lead first and foremost by example. Every now and then it's a good idea to look
back and see if anyone is following. If
not, it's worth evaluating the example being set using a very simple but
critical question: "What's the right thing to do?"
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