Overcoming Adversaries

Problem: 

“Our hospital is generally regarded as having great physicians who provide excellent care.  However, our physicians are split on peer review:  Some feel it is of undeniable benefit to quality while others feel that while it is beneficial, it’s not worth the trouble it creates.  The adversaries cite past abuses of peer review.  How can we overcome the objections?”

Solution: 

Although excellent peer review practices are paving the way for widespread acceptance and favorable impact, this remains a very common and unfortunate problem. While there is clearly growing appreciation for peer review’s potential and value, many remain skeptical if not downright adversarial. Rooted in their own negative experiences, some physicians have even taken their anti-peer review cause to a whole new level, fighting it through organizations of people who feel victimized by peer review. While not all of their causes may be just, many, no doubt, are. Nothing would incite a physician more than when he or she falls victim to corrective action that was driven largely by the results of suspect conduct by leadership. Even the term “sham peer review” has become well recognized in some circles.

But no more than the term “unnecessary surgery” means that all surgery is unnecessary does the term “sham peer review” mean that all peer review is a sham. As with patient care, there are right ways and wrong ways to conduct peer review; the consequences of either can be significant. Let’s remember that people, not processes, make decisions.  Within the context of the medical staff bylaws, peer review is but one of many tools that leaders use to manage the quality and risk for which they are responsible. It is when this tool is used carelessly and without regard to widely held principles that it becomes dangerous for all involved.

Often, where there is smoke, there was fire: Adversaries come from bad experience. As addressed in prior editions of ProblemSolved, flawed processes, inadequate policies, overlooking the importance of seeking and incorporating the input of key stakeholders, and failure to build the entire program on a solid foundation, can each foster resistance. As we look deeper into the problem of resistance, we often find objections rooted in leadership behaviors that reflect a lack of appreciation for what peer review is…and what it is not. Peer review is not a weapon or a competitive tool. It is not just for “problem physicians”. It is a highly valuable quality and risk management tool that should involve and have the support of all physicians. To realize its potential and maintain physician support, peer review must be balanced and fair, consistently applied, and handled with the utmost sensitivity and confidentiality.

High integrity peer review programs have leaders who are constantly vigilant, making sure that peer review is never abused or misused, but rather, always utilized as an instrument to maximize patient care quality and safety. Without such vigilance from leadership, expect failure and resistance. With it, the great potential peer review offers can be achieved.