During a session at the Becker’s Hospital Review 4th Annual Meeting in Chicago on May 11, Dr. Lang advocated physician peer review as an effective strategy for improving performance, and shared five strategies for employing peer review among physicians.
1. Set expectations. Dr. Lang advocates making it clear that physician peer review is a deeply integrated part of the hospital’s functions. “Put it in physicians’ contracts,” he said, and have a quick conversation with a quality compliance officer to be a part of the interview process. “Say from the start, ‘We care about patient safety and quality,’” and peer reviews are part of that process, he said.
2. Create a safe forum to learn from adverse events. “If the system is punitive, it will not work,” said Dr. Lang. Physicians will “circle the wagon and clam up” to protect themselves and their colleagues, he said. Instead, Dr. Lang advises focusing on risk management and patient safety to engage physicians in the process.
3. Know what (and who) to review. A hospital administrator should help decide which cases to review, and identify these cases based criteria such as outcomes, patterns with a certain physician or patient complaints, said Dr. Lang. He also recommends interfacing between departments to review a case to extend accountability to lab technicians, radiologists and others.
4. Be respectful of physicians’ time. Dr. Lang suggested providing administrative support for physicians during the review process: “The guy making three bucks a minute shouldn’t be shuffling papers.” A simple appeal process should also exist for physicians to easily respond to a peer review, he said.
5. Share results (in print, or over meals). The most important step is to share the results of the peer reviews so it can become a learning experience for everyone, whether in print or in person. Dr. Lang mentioned that discussing results over a meal creates a “super congenial” atmosphere for discussing any issues raised by the reviews.
Physician peer review can be very beneficial for a hospital. When everyone knows quality could be improved, they will act, said Mr. Lang. “The results are worth it,” he said.