Hospitals Can Improve Quality Through Effective Peer Review Evaluations

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AllMed Healthcare Management says challenges that most facilities face can be overcome through best-practice steps that focus on improving peer review committee operations.

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"Hospitals with well-functioning peer review operations are doing a good job in evaluating the performance of their practitioners," said Andrew Rowe, CEO, AllMed Healthcare Management

Hospitals continue to find it challenging to evaluate the performance of their practitioners and improve the quality of the care they deliver. According to AllMed Healthcare Management, it is a problem that can be linked to a breakdown in the peer review process. In a recent online discussion with healthcare executives, the company said the solution lies specifically in improving peer review committee operation.

Hospitals that do have well-functioning peer review operations – and which are doing a good job of evaluating practitioners – recognize the importance of several key success factors. These include having peers reviewing peers, identifying and eliminating conflicts of interest, and establishing effective administrative processes.

The leaders of best-practices hospitals know that acknowledging these factors is essential to improving their physicians’ performance, and will lead to better clinical outcomes and better service to their patient populations and communities.

But, how is a hospital to know that its peer review evaluation process is ineffective or has broken down? According to Andrew Rowe, CEO of AllMed Healthcare Management, an external peer review organization, the most common indicators are:

  •     Leadership not communicating expectations to medical staff and the peer review committee
  •     Too many peer review decisions viewed as arbitrary or punitive in nature
  •     Practitioner evaluations not being conducted in a timely or consistent manner
  •     Lack of available staff to conduct reviews
  •     Evidence of conflict of interest among peer review committee members and and practitioners

Successfully dealing with these problems involves several key steps, beginning with leadership establishing performance expectations, and then working with medical staff to define core competencies expected in practitioners.

Next, it’s best that peer review committees perform ongoing measurement and monitoring of practitioner performance (not just at times of re-appointment or in the case of sentinel events). A committee should investigate all deviations from performance expectations, using both data and case reviews to make competency decisions.

Also there should be a commitment to focused evaluations that help practitioners understand and correct identified deficiencies; and triggers established for more focused evaluations, such as in the case of increased negative outcomes, improper treatments, or disruptive practitioner behavior.

Written policies are important, in order to document the factors that can lead to conflict of interest (COI), and to guide peer review committee members in properly identifying it so leadership can effectively manage it. Also important is having well developed processes for external peer review, which leading hospitals utilize in sensitive situations or when internal peer review committees are unable to objectively evaluate cases.

Lastly, best-practices hospitals have an ongoing process for evaluating the performance of their peer review committee and processes, using a peer review scorecard. This can include a simple rating scale to identify a program’s strengths and weaknesses and help in measuring progress.
“Effective practitioner evaluation requires a tight connection between hospital leadership and the peer review process. Hospitals that ensure this connection avoid the consequences of medical errors, ensure that their practitioners are consistently performing to standards, and are recognized for continually delivering high quality care,” Rowe said.

For more information, download the white paper “Building Effective Peer Review: Practitioner Evaluation".

About AllMed Healthcare Management
Founded in 1995, AllMed conducts external peer reviews for leading hospital groups, ASCs and other healthcare providers. Also, it is a first-level independent reviewer for leading health insurance payers, third-party administrators, and claims 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

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Andrew G. Rowe

Bill Trainer
The Public Relations Project, Inc.
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