This article is a continuation from our initial article discussing the complexities of Peer Review.
Recently, with the attempt to increase patient satisfaction and safety, the current trend has been to establish checklists and strict protocols for providers to follow rather than relying on their experience and individual judgment. As you can imagine, the art of medicine loses appeal as the artist’s canvas is removed and replaced with a paint-by-number set to perform by. Apply this analogy to the expectations of physicians today and it’s easy to understand the bristling and push back to new and stringent methodologies. Moreover, as the medical staff service administrator, quality director or healthcare executive initiates the paint-by-number approach to performance, it may feel as though all involved are struggling to fit “square pegs in round holes.” wooden board with square peg in round hole
Below are successful techniques we’ve seen alleviate disdain and promote positive outcomes for providers and the organization:
Acknowledging the difficulty of this dramatic change:Change is always difficult, even in the best situations which makes it’s imperative to listen to physician concerns and address them appropriately. A successful program cannot be built in a vacuum, physicians should be an integral part of implementing new policies, procedures and checklists to ensure the process is practical and generates provider buy-in.
Don’t rely on standards and mandatory requirements to make the case: This technique is akin to the “because I told you so” routine used by parents. It doesn’t work on a 15-year old and it certainly won’t convince a highly-educated practitioner that the way they’ve been practicing for years should now conform to the ‘new and improved’ way of practicing medicine.
Present evidence and sound research: Allow the evidence and research that determined a particular care path or outcome measure to speak for its self. These new approaches have been researched, vetted, discussed and performed ad nauseam prior to consideration for publication. Ultimately, a physician’s desire is doing what’s best for the patient. Providing doctors with sound, documented research will shed light on the benefits of adoption. Delivering the message can often be as important as the message itself, the presentation should be reinforced multiple times in various formats and venues; this is a cultural change in the way you do business.
Describe the relevance and future of professional performance and reporting: These new requirements are here to stay. In fact, a recent article by Sharon H. Fitzgerald in the June issue of Nashville Medical News discussed the need for change in curriculum to educate aspiring physicians of the expectations for practicing today and in the future. Vanderbilt, as well as other medical schools, is vying for a special grant being awarded by the American Medical Association to measure the effectiveness of these changes in how graduating physicians understand and adapt practice development with the new concepts.
OPPE (Ongoing Professional Practice Evaluations) are beginning to include performance expectations tied to outcome measures. In 2014, CMS will initiate a “Physician Compare” publicly reported web site allowing patients and payor groups to compare performance and outcome ratings for group practices with individual practices reported similar to the current “Hospital Compare” website. Today, many insurance groups either publicly or privately maintain “Report Card” type documents to be used for determining reimbursement eligibility, enrollment membership and the like.
Navigating the litany of requirements, mandates and standards can create an environment of uncertainty and confusion. Quality and Medical Staff professionals assigned to maintain these processes are overwhelmed. A well articulated Peer Review program can efficiently serve the hospital’s clientele by creating a program that clearly delivers professional tracking and trending of performance and outcome measures as well as assist physicians with a support system that includes preparation for the fast track of change in healthcare.