Four Major Challenges of the Peer Review Process

Did you know that an effective peer review process at your healthcare facility can have a major impact on quality of care? In its broadest sense, peer review has a direct affect over a health organization’s quality assurance and performance improvement activities. Having a failing peer review process can lead to both major financial and legal problems. That’s why it’s important to understand the inherent challenges of peer review to avoid having a weak review system. 

The Challenges of Peer Review

Peer review was developed to help organizations improve their quality of care. However, conducting a peer review process that lacks organizational oversight can lead to a faulty process. Here are four major challenges that can make it difficult to distinguish between an effective peer review process and a process that is “good enough.” 

1. Peer Reviews are Technical 

Peer reviews use standards that are set by the state or a regulatory agency. Medical staff members that meet these standards are considered fit for practice. As such, efforts to make improvements tend to stop there. However, you should keep in mind that these standards are the minimum requirements needed for practice. This can make identifying progress beyond the minimum difficult.

2. Quality is Defined by Culture

A healthcare organization’s culture has a major influence over how it treats peer review results – especially since it defines high and low quality care, as well as how to approach change and improvement. Organizations with a low priority for safety will tend to have a much harder time making major changes to improve quality of care. 

3. Holding a Distrust of the Peer Review Process

Another major hurdle occurs when the medical staff distrusts the peer review process. It’s common for medical staff to be skeptical of how results will impact their practice. However, depending on how you manage negative reviews, the process itself can be perceived as punitive or a “witch hunt.” This can lead to biased reviews that fail to meet peer review goals. 

4. Inconsistent Approaches

What happens when organizations experience frequent, significant leadership changes? In all likelihood, you create major inconsistencies in your peer review methodology. Different leaders will

have their own method of dealing with quality issues. This can be a major problem for long-term medical staff, who must face an ever-changing set of beliefs. 

Failing to factor in these challenges can lead to peer review processes that worsen the mistakes made by the medical staff. Ultimately, this adds up to an increased risk of harm to patients, colleagues, as well as financial losses and litigation. 

Financial Implications of a Failed Peer Review Process

For starters, a weak peer review process can lead to decreased reimbursements by payors and a loss of business. Most peer reviews are tied to regulatory agencies like Medicaid and Medicare that require certain standards. Without a robust review process, an organization can lose this business, which can have a big impact on your bottom line. 

The Risk of Litigation Due to a Failed Peer Review Process

Even worse are organizations with ineffective review processes who become at risk of Negligent Credentialing. Consider this is state law: A hospital has a direct and independent responsibility to its patients, over and above the physicians and surgeons practicing therein, to take responsible steps to (1) ensure that its medical staff is qualified for the privileges granted and/or (2) to evaluate the care provided.1

Simply put, Negligent Credentialing is when a third-party sues a health organization because they allowed the patient to be harmed. This can result in major punitive damages, as well as a damaged reputation. 

Ultimately, conducting an effective peer review system comes with many inherent challenges and hurdles. These can be overcome by your organization’s culture and dedication to creating a fair and reputable process. Failing to address these challenges can lead to major legal and financial consequences. 

With risks of negligent credentialing and unfair physician hearings always looming over your head, it’s no easy feat to get your entire organization following a consistent peer review process. Peer Review software by symplr provides an easy way to automate your paper processes to provide a consistent and repeatable workflow that everyone involved in peer review can appreciate. To learn more about symplr's Peer Review software, schedule a demo now! Gain insight on the legal implications of peer review with our webcast series titled, Why and When to Use Peer Review: Understanding the Legal Significance, Benefits and Challenges. This webcast is presented by special guest Brian C. Betner, Esq., Vice Chair of the medical staff credentialing and peer review practice group of the American Health Lawyers Association. 

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Melissa Outlaw

About the Author
Melissa Outlaw

Melissa Outlaw is a Vice President, Customer Success with symplr. Melissa and her team assist clients in learning and implementing our provider management software - credentialing, privileging, peer review, quality and event reporting applications. She supports clients in benchmarking current internal practices, identifying potential efficiencies, then driving the integration of technology with process improvement to reduce time of service and operating expenses. She works extensively with decentralized, multi-facility organizations in transitioning to a shared service center as well as assisting healthcare organizations bridge the gap between procedures performed by a provider and their privileges granted.

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