PROBLEM Medical peer review is not a new concept. In Ethics of the Physician, Syrian doctor, Ishap bin Ali Al Raha, (854-931) recommended that physicians keep excellent records such that if a patient died or was cured, the notes could be examined by local medical counsel to determine if the care had been appropriate.
Throughout much of modern medicine, the predominant process of peer review was the audit. Quality Assurance became formalized in 1979, the chief goal being to determine if the standard of care had been met. This process was often perceived as adversarial- the CMO brought an indictment of a provider and that defendant answered with defense counsel. Blaming created a culture of fear, secrecy and defensiveness. Providers would …show more content…
Physicians had little engagement in quality improvement. Review by a single individual often resulted in both retrospective and personal bias. Consistent with most other institutions, there was minimal reporting of incidents, with a significant time lag between occurrence and review. The process was not transparent- there was minimal to no interaction with the subject provider nor knowledge of the outcome of review. It was difficult to find reviewers, as physicians were reluctant to break the “blue line” of …show more content…
We hope to establish a SharePoint with de-identified results of PPEC to facilitate learning from all medical staff. We also intend to find a way to maintain confidentiality while allowing resident participation. Finally we need to identify a process for patients to become part of peer review, as anyone involved in the problem should be part of the solution.
We still need a formal program to identify and deal with persistently problematic providers and we would like to see the culture to be so supportive that physicians self report.
Presently PPEC functions only at Magee Womens Hospital. Our goal is to use our work as the model for other hospitals in the UPMC system. PPEC is also only used in an inpatient setting. The outpatient setting is where the majority of patient care occurs and yet there is minimal, if any peer review. We hope to eventually translate PPEC into a workable outpatient model as well.
Another next step is to use PPEC to celebrate excellence. Presently, peer review still looks only at adverse outcomes. This could also be an opportunity to learn from our successes and educate other departments throughout the
Throughout much of modern medicine, the predominant process of peer review was the audit. Quality Assurance became formalized in 1979, the chief goal being to determine if the standard of care had been met. This process was often perceived as adversarial- the CMO brought an indictment of a provider and that defendant answered with defense counsel. Blaming created a culture of fear, secrecy and defensiveness. Providers would …show more content…
Physicians had little engagement in quality improvement. Review by a single individual often resulted in both retrospective and personal bias. Consistent with most other institutions, there was minimal reporting of incidents, with a significant time lag between occurrence and review. The process was not transparent- there was minimal to no interaction with the subject provider nor knowledge of the outcome of review. It was difficult to find reviewers, as physicians were reluctant to break the “blue line” of …show more content…
We hope to establish a SharePoint with de-identified results of PPEC to facilitate learning from all medical staff. We also intend to find a way to maintain confidentiality while allowing resident participation. Finally we need to identify a process for patients to become part of peer review, as anyone involved in the problem should be part of the solution.
We still need a formal program to identify and deal with persistently problematic providers and we would like to see the culture to be so supportive that physicians self report.
Presently PPEC functions only at Magee Womens Hospital. Our goal is to use our work as the model for other hospitals in the UPMC system. PPEC is also only used in an inpatient setting. The outpatient setting is where the majority of patient care occurs and yet there is minimal, if any peer review. We hope to eventually translate PPEC into a workable outpatient model as well.
Another next step is to use PPEC to celebrate excellence. Presently, peer review still looks only at adverse outcomes. This could also be an opportunity to learn from our successes and educate other departments throughout the