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QUESTION:    Our peer review process uses a case review form that asks physicians to score cases:

1 is  “exemplary care,”
2 is “meets the standard of care,”
3 is “below the standard of care,” and
4 is “significant deviation from the standard of care.”

It seems most of our cases end up being a 2, even when there are concerns.  Is there a better way?

 

ANSWER:      Yes!  Ditch the scoring, and adopt a new form that focuses on narrative explanations to answer three key questions:

(1) is there a concern?;
(2) if so, what’s the nature of the concern?; and
(3) how can the concern be addressed?

One problem with “scoring” cases (or otherwise categorizing them) is that the focus of the review becomes assigning a score rather than fixing any concerns that are identified.

Also, physician reviewers may be uncomfortable indicating that a physician’s care was “below the standard of care.”  As a result, they choose a more favorable score even if there are concerns.

If reviewers are willing to say that care falls “below the standard” or was “inappropriate,” the physician who receives the score is more likely to be on the defensive.  This undercuts efforts to make the peer review process educational rather than punitive.

For more tips on how to make your peer review process more effective, join us in San Francisco from Nov. 15-17 for The Peer Review Clinic.