This current 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 healthcare leadership experience.
Problem:
"Why does MDReview ask us to provide a cover letter with each case for external review? What should this letter contain? How do we write it in such a way as to not bias the reviewer?"
Solution:
Simple or detailed, a cover letter is integral to effective
external peer review. While MDReview
learns a great deal about each case to make sure we recommend the best strategy
and reviewer, we believe that a succinct written communication between our
client organization and the reviewer is highly important. An appropriately written cover letter does
not inject bias, but rather outlines the important issues to be addressed by
the reviewer. Each case brings its own
set of complexities and there can be no assurance that all key issues can be
recognized and addressed by the reviewer. Even the best of reviewers can't always see every nuance-especially
given the highly complex cases we tend to see at MDReview. A well worded cover letter focuses the
reviewer on the aspects of care most important to leadership. It is best that this letter comes directly
from organizational leadership without having it filtered by anyone, including the
MDReview team.
Some cover letters reflect the strategy that the less the
reviewer knows, the better, or that there are no specific aspects of care that
have been targeted for review. While
this "less is more" approach is certainly defensible, there are also good
reasons to outline specific areas of interest that have been identified.
In a prior edition of ProblemSolved, I made the point that peer
review is not a report, but a process. After submission of the final report, the reviewer can provide
additional information or answer follow up questions if the report fails to
address all key concerns. However, a
carefully worded cover letter not only ensures that identified issues are
addressed in the final report, but also serves to reduce the likelihood of
extending the time necessary to complete the peer review process. The more the reviewer knows up front about
leadership's questions, the higher the likelihood for the reviewer to address
all the important aspects of the case in the written report without prolonging
the process.
What makes for an effective cover letter? It is free of emotion. It does not state conclusions or leanings
reached by anyone including the peer review committee or other clinicians. It asks specific questions or outlines areas
of focus that are free of any bias. And
it provides no superfluous information that can give the reviewer any favorable
or unfavorable perception of either the subject physician or the care provided. Including a brief overview of the case can be
helpful, but the same standards apply.
Making the request "Please address the deficiencies related
to management of complications that resulted from technical surgical errors" is
full of bias. It shows that opinions
have been formulated regarding both surgery and management of complications. A better formulation of the request would be
"Please address the surgical complications as well as the subsequent management
of those complications." This focuses
the reviewer on what leadership finds important without putting the reviewer in
a position of having to agree or disagree with established opinions, in other
words, without injecting unnecessary bias. Further, stating that the subject physician is known to be disruptive or
is highly popular among his colleagues is information that is not only
unnecessary, but can taint the reviewer's thinking. Certainly, such statements can bring into
question the validity of the review by anyone who is threatened by its
findings.
An
effective cover letter focuses the reviewer's attention to aspects of the care
as documented in the medical record without compromising the outcome of the
review by injecting unnecessary bias. It
is supportive of the highest integrity peer review while minimizing process
delays.
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