Nonpunitive Peer Review: Emphasizing Learning

Hospitals and health systems are beginning to overhaul their medical peer review programs to eliminate the “shame-and-blame” approach of singling out individual physicians for inappropriate practices. Instead, their peer review programs provide physicians with data, collected by the organization, that compares their individual practices with their department’s or their hospital’s norm. Physicians who see that their practices are not up to par with their peers’ are usually motivated to change their behavior without further prompting from the healthcare organization.

Despite the enthusiasm of those who have retooled their peer review systems in this manner, other organizations are struggling to adopt similar approaches. Many healthcare organizations still have in place the “old school, decentralized, punitive method of peer review,” says Steve B. Lowenthal, M.D., M.P.H., senior vice president, medical affairs, and chief medical officer, Rush-Copley Medical Center (Aurora, Illinois).

One barrier that prevents organizations from changing to a proactive peer review system involves having limited resources to devote to a process that everyone agrees requires an investment in time, people, and information systems to acquire the necessary data to track and identify trends in physician performance patterns. “It is exceedingly resource intensive,” says Gerald Hickson, M.D., director, Center for Patient and Professional Advocacy, and associate dean for clinical affairs at Vanderbilt University Medical Center (Nashville, Tennessee).

Also, organizations must overcome lingering physician resistance to historic peer review processes that their medical staffs have regarded as punitive. “It has to be viewed as constructive and something that will help a physician. It’s changing that culture,”...