Effective Hospital Peer Review Hinges on Leadership Engagement and Support

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Without leadership involvement, peer review processes are destined to fail or stagnate, and negative clinical outcomes and unintended consequences are more likely to persist

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Unless the problem is addressed, physician deficiencies will continue to go unreported or under-evaluated, preventable medical errors will continue to occur, and hospitals will continue to incur unnecessary costs.

Hospitals recognize that peer review is essential to improving physician performance, ensuring the delivery of the highest quality of care, and guarding against physician practices that can lead to significant cost and legal issues. At the same time, however, in still too many institutions, effective peer review is not in place because leadership and cultural issues have impeded its implementation or execution.

This statement is based in fact. In a recent survey, AllMed Healthcare Management polled 80 hospitals across the country. At least one third of these hospitals said their leadership does not support peer review and many in the study said peer review is viewed negatively. “This explains why we still have too many poor performing physicians treating patients,” said AllMed’s CEO, Andrew Rowe. “And unless the problem is addressed, physician deficiencies will continue to go unreported or under-evaluated, preventable medical errors will continue to occur, and hospitals will continue to incur unnecessary costs.”

Rowe made this prediction in a recent webinar attended by more than 130 hospital executives and medical leaders. He was joined in the discussion by Mark Smith, M.D, a practicing vascular surgeon at the University of California, Irvine Medical Center, Orange, Calif., and part of the team of Salem, Wisconsin-based HG Healthcare Consultants, whose business is helping hospitals establish effective peer review systems. Smith echoed Rowe’s comments, saying, “Hospital peer review continues to suffer from leadership paralysis. But pressures to improve outcomes should spur executives and boards to take action. If they don’t do it themselves, it will surely be done for them.”

Rather than wait for that to occur, Rowe and Smith urge hospital leaders to commit to a healthy culture now. Steps they should take include:

  • Take a hard look at the current situation, understand what is not working and fix it
  • Put written peer review bylaws and procedures in place and ensure they are followed
  • Establish an organizational structure that encourages and rewards participation
  • Insist on oversight, performance measurement, review follow-up and training
  • Learn how to recognize peer review breakdowns and prevent them from re-occurring

“It is also critical for leaders to understand that an effective culture acknowledges that internal peer review alone is not enough,” Smith said. Forces or factors that can hinder success include conflict of interest among reviewers and physicians, an insufficient number of qualified reviewers, unresolved quality issues, and physician behavior that adversely affects clinical outcomes.

For these and other reasons, external peer review organizations play an important role. “These entities are not subject to inside influences, they have specialists on staff that hospitals often lack, and because they are external to the organization, they can make recommendations to leadership that are more likely to be well received and acted upon.”

For more information about building effective peer review leadership and a supportive culture, go to the AllMed’s recent webinar. A white paper is also available for download, and questions can be directed to AllMed.

About AllMed Healthcare Management
Founded in 1995, AllMed conducts external peer reviews for leading hospital groups, ASCs and other healthcare providers. It also provides independent medical review services for leading health insurance payers, third-party administrators and medical management organizations nationwide. All reviews are conducted by AllMed’s medical team, which includes more than 400 licensed, board-certified physicians in who are in active practice. For more information, visit http://www.allmedmd.com.

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Andrew G. Rowe

Bill Trainer
The Public Relations Project, Inc.
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