A continuation of our series Peer Review - Balancing Peer Review with the Art of Medicine: Part III
If an organization has adopted the steps previously outlined in our peer review series (simplified requirements and processes, leveraged technology to improve workflows and reporting, utilized techniques to promote positive provider outcomes, etc.) they may still find their Peer Review Process in need of additional change. When upheld in an atmosphere of cooperation and professional respect, improvements in outcomes and care become the focus of the entire process as it was intended.
Most organizations find accountability difficult to maintain in any performance improvement endeavor and unfortunately working with physicians and allied health practitioners adds additional layers of complexity. Physicians are trained to be independent thinkers, assertive and confident in the decisions they make. It’s often difficult to approach providers with strong personalities and report the need to make changes, especially those practicing more than 20 years. Better yet, imagine being the physician approached by a random reviewer, usually a nurse or possibly someone with little or no medical training, who works in an office or cubicle.
Introducing accountability can be as abrupt as slamming the proverbial “hammer on the table” or it can be eased into over the course of a year or two. These are some strategic ways to implement a peer review plan to increase collegial accountability, teamwork, communication, and goal setting while creating a safer environment for patients.
Identify official and unofficial healthcare leaders: Your Department Chairs, the CEO, CFO and other leaders should be a part of and publicly supportive of the transformation. Additionally, there are other well respected colleagues who are viewed as influential leaders, but without current official status. Both groups are intricate pieces in setting the expectations for accountability throughout the organization. A successful program is likely doomed without all of their acceptance and public support.
Encourage team building: The departure from individual groups to becoming a team focused on overall healthcare delivery is vital. This isn’t necessarily a step to check off but a goal for the organization to meet. As team members work together and begin to communicate more regularly, accountability to the system grows as does the ability to tackle otherwise difficult discussions related to changes in practice.
Immediately address physician issues, one on one: Challenges will likely arise as new processes and measures are introduced. A slow response in dealing with issues will allow providers an excuse to revert back to the way things were. Any and all issues must be addressed in short order to reinforce the validity of the program.
Improve system or process issues as they arise: The best laid plans won’t account for every contingency your organization may face. This is a fluid environment which demands flexibility needed to address unforeseen issues. Executives and administrators will need to move quickly, removing obstacles and facilitating a prompt response to support the program while all involved ensure newly adopted policies are documented for future reference.
Educate all hospital staff of new standards: An easily overlooked step in the introduction of a successful Peer Review Program is the inclusion of the entire clinical team regarding expected outcomes, goals, performance measures and processes. Sharing an understanding of performance expectations for all involved will encourage team building, transparency and a sense of ownership in the care delivered. Publicizing information regarding hospital, government and specialty measures can assist in tearing down walls known to have plagued healthcare culture in the past.
Acknowledge and address perceived challenges: If there is a particular measure that will challenge your team - be sure to address it. If necessary, it may be beneficial to break the measure into steps, creating mini goals and setting attainable time frames to meet them. People in healthcare are typically goal oriented and like to see improvement. Creating mini goals with realistic time frames provides the satisfaction of achievement that can eliminate the stress of having insurmountable challenges too difficult to attain.
Introduce transparency to the process: The overarching culture of healthcare is so ingrained with confidentiality stemming from HIPPA, Codes of Conduct and legal matters - that it oftentimes and inadvertently makes us nervous to share nearly anything. Within the facility, Peer Review as a process is protected and what occurs within that process and how information is shared and deliberated is decided by each individual facility. Physician names, reports, measures, and patient names utilized within the Peer Review Team are not required to be confidential. Gently removing these unnecessary barriers will eventually create an atmosphere and culture of Performance Improvement not constrained by fear of risk.
Establishing Accountability in the Peer Review Process is another step in helping your organization reach its goals, reap rewards and make all this worthwhile. The benefits include increased revenue, decreased cost, improved provider performance, increased provider satisfaction, and ultimately the most important measure of all, improved quality of care for your patients.