This current
problem is addressed by Jon Moses, MHA. Mr. Moses is the President and CEO of
MDReview which he co-founded. He is a former hospital CEO with over 25 years
senior healthcare leadership experience.
Problem:
"As we discuss our peer review case screening criteria, some members of our peer review committee are adamant that we take a "no harm, no foul" approach to our peer review program--that our focus should be only on cases with detrimental impact on the patient. Is this a reasonable strategy?"
Solution:
It is quite common for hospitals to conclude that
if a patient was not harmed, there was either no deviation from standard of
care or the deviation was of little significance.
As part of MDReview's own ongoing training and quality
monitoring, we carefully evaluate every draft report to ensure that our peer
reviewers do not equate standard of care with outcome. We feel it is unreasonable to rule out
deviations from standard of care on the basis of an acceptable outcome or the
absence of patient harm. Driving under
the influence of alcohol is not acceptable regardless of whether or not someone
is harmed. Similarly, poor clinical performance
is not acceptable regardless of the outcome. The next time, someone could be harmed. We do not allow a reviewer to be critical of clinical practice and then
conclude that standards of care have been met simply because the patient was
not impacted by the deficiencies in care.
Likewise, adverse outcomes do not necessarily imply poor
care. But, adverse outcomes should be a
consideration for case screening even though the best of care can lead to
undesired results. Effective quality
management recognizes that monitoring systems should look not only for patient
harm, but also for potential patient
harm. The best quality management
implements changes before anyone is harmed. Case screening criteria should be developed and employed regardless of
patient impact or outcome.
Screening criteria must be sensitive to each specialty as
well as to local characteristics. Widely
used criteria for focused professional practice evaluation case selection
includes, but is certainly not limited to, unexpected readmissions or returns
to surgery, sentinel events, adverse patient outcomes, patient complaints, peer
concerns, requests for new privileges, abnormal complication rates, unusual or
disruptive behavior and aberrant utilization rates. While patient harm is an important consideration,
the lack of patient harm should not exclude cases from peer review.
A "no harm, no foul"
approach diminishes the quality improvement potential your peer review program
holds for your organization and those it serves.
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