Question:

I attended The Peer Review Clinic in Monterey, California in November. We are in the process of revamping our process based on your recommendations.  The faculty recommended not using a scoring system for peer review cases. If a scoring system is not used, how should we report the results of the process?

Answer:

We do not recommend incorporating a scoring system into the peer review process for several reasons.  Our experience has been that when a scoring system is used, the score given to a case becomes the whole focus of the process, as opposed to identifying whether there is, in fact, a concern with the care provided in a particular case and determining the appropriate intervention to address that concern.

In addition, scoring systems often include descriptors from “standard of care met” to  “standard of care not met,” to “serious deviation from standard of care,” or sometimes even “unexpected and catastrophic adverse patient outcome due to care.”  Hopefully, the state peer review statute would protect those findings from discovery in a malpractice case but if they were discovered or admitted, they would be very detrimental.  In addition, most physicians would be very uncomfortable applying such a description to the care rendered by a colleague. Thus, too often, the outcome of reviews is not to take any action or intervention but to continue to “trend” to see if a pattern develops.  Unfortunately, that forfeits an opportunity to help a colleague improve his or her clinical practice and may put patients at risk.

Rather than reporting “scores,” consider developing reports for individual practitioners and for departments that reflect the reasons that cases are reviewed, the findings of the reviewers and the final determination or the interventions implemented – “No further review required,” “Educational letter,” “Collegial intervention,” or “Performance Improvement Plan.”  Such reports are more informative than those that simply report scores.  Samples of such reports are available on our website.

(The Peer Review Clinic will be offered March 1-3 in Washington, D.C. and April 12-14 in Chicago.  More information is available here.)