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 hospital is generally regarded as having great physicians who provide excellent care. However, our physicians are split on peer review: Some feel it is of undeniable benefit to quality while others feel that while it is beneficial, it's not worth the trouble it creates. The adversaries site past abuses of peer review. How can we overcome the objections?"
Solution:
Although excellent peer review practices are paving the way
for widespread acceptance and favorable impact, this remains a very
common and
unfortunate problem. While there is clearly
growing appreciation for peer review's potential and value, many remain
skeptical
if not downright adversarial. Rooted in
their own negative experiences, some physicians have even taken their
anti-peer
review cause to a whole new level, fighting it through organizations of
people
who feel victimized by peer review. While
not all of their causes may be just, many, no doubt, are. Nothing would
incite a physician more than when
he or she falls victim to corrective action that was driven largely by
the
results of suspect conduct by leadership. Even the term "sham peer review" has become well recognized in some
circles.
But no more than the term "unnecessary surgery" means that
all surgery is unnecessary does the term "sham peer review" mean that
all peer
review is a sham. As with patient care,
there are right ways and wrong ways to conduct peer review; the
consequences of
either can be significant. Let's
remember that people, not processes, make decisions. Within the context
of the medical staff
bylaws, peer review is but one of many tools that leaders use to manage
the quality
and risk for which they are responsible. It is when this tool is used carelessly and without regard to widely
held principles that it becomes dangerous for all involved.
Often,
where there is smoke, there was fire: Adversaries come from bad
experience. As addressed in prior editions of ProblemSolved,
flawed processes, inadequate
policies, overlooking the importance of seeking and incorporating the
input of
key stakeholders, and failure to build the entire program on a solid
foundation,
can each foster resistance. As we look
deeper into the problem of resistance, we often find objections rooted
in
leadership behaviors that reflect a lack of appreciation for what peer
review
is...and what it is not. Peer review is
not a weapon or a competitive tool. It
is not just for "problem physicians". It
is a highly valuable quality and risk management tool that should
involve and have
the support of all physicians. To
realize its potential and maintain physician support, peer review must
be
balanced and fair, consistently applied, and handled with the utmost
sensitivity and confidentiality.
High integrity peer review programs have leaders who are
constantly vigilant, making sure that peer review is never abused or
misused,
but rather, always utilized as an instrument to maximize patient care
quality
and safety. Without such vigilance from
leadership, expect failure and resistance. With it, the great potential peer review offers can be achieved.
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