QA to QI LLC is an AHRQ-listed Patient Safety Organization authorized to provide services in conformance with the Patient Safety and Quality Improvement Act of 2005. QA to QI is also a designated Connecticut Patient Safety organization authorized by the Connecticut State Department of Health to provide services under CGS 19a-127o.

QA to QI supports the efforts of healthcare providers and other Patient Safety Organizations to improve quality and patient safety. My firm is dedicated to research and innovation to fix dysfunctions in healthcare management. See my whitepaper outlining a framework to identify promising leverage points for improvement in patient safety.

Through my client work, 3 national studies and 8 journal articles, I have acquired unique expertise in how to use clinical peer review as an effective tool to improve quality and patient safety. I have identified the prevailing dysfunction in event analysis as a major barrier to development of a culture of safety and high reliability among both physicians and nurses.

My firm specializes in facilitating best practices in event analysis and in collecting and analyzing the data needed to improve peer review program management for all disciplines.  It also enables protected self-reporting (see related whitepaper) as a strategy to improve the case identification process and to engage healthcare professionals in a culture of safety. In contrast, most other PSOs are focused on organizing improvement collaboratives, "Safe Tables" learning discussions, and/or on general reporting and analysis of patient safety incidents.

A Conceptual Framework for Improving Patient Safety

Conceptual Framework for Patient Safety Improvement

The Affordable Care Act § 1311(h)(1)(A) mandated that all hospitals over 50 beds must establish a Patient Safety Evaluation System and, thereby, a Patient Safety Organization relationship by January 1, 2015 in order to contract with a Qualified Health Plan. On March 11, 2014, CMS issued a final rule that delayed this requirement until at least January 17, 2017 and, in the interim, simply required hospitals to have Medicare certification (see § 156.1110 on page 99 of 101).

Even so, as I pointed out in my public (comments on the proposed rule), nearly all hospitals over 400 beds and more than half of those over 200 beds had already established a PSO relationship by the end of 2013 because it makes good business sense.

On March 8, 2016, CMS made further modifications to the final rule that gives the option to either establish a PSO relationship together with a mechanism for comprehensive person-centered hospital discharge to improve care coordination and health care quality for each patient; or to implement an evidence-based initiative to improve health care quality through the collection, management and analysis of patient safety events that reduces all cause preventable harm, prevents hospital readmission, or improves care coordination.

Services for Healthcare Providers

Federal Protection for Clinical Peer Review and Related Event Reporting


Available to My PREPTM and PREP-MSTM Clients without additional fees

Sample PSO Services Agreement

State of Connecticut Statutory Compliance for Hospitals and Outpatient Surgical Facilities

A low-cost option that allows simultaneous reporting of a copy of Connecticut Patient Safety Work Product to a federal PSO's Patient Safety Evaluation System and, thereby, contribute to aggregate learning for improvement at a national level. See: What should Connecticut Providers Do?

Services for Patient Safety Organizations

Sample PSO Support Agreement

Frequently Asked Questions about PSO Services

Additional Tools and Supports for Improved Clinical Peer Review Practice

Cooperative Projects
Normative Peer Review Database Project
Ideal Peer Review Process Collaborative
Clinical Peer Review Innovation Showcase
Site Visit: A jump-start for organizational improvement
The Peer Review Enhancement ProgramSM aka PREPSM
DataDriverSM: Methodology to leverage data to improve organizational performance
From QA to QISM: Custom solutions for organizational change and process improvement
Peer Review Enhancement Program Management SystemTM aka PREP-MSTM: Total software support for the QI Model
My PREPTM: A complete, affordable, integrated package for do-it-yourself clinical peer review program improvement
Medical Staff Opinion Survey : A simple, cost-effective tool to monitor medical staff perceptions of the hospital and its quality-related programs
Clinical Peer Review Program Self-Assessment Inventory: A free, brief, evidence-based self-assessment inventory using the QI Model now available online


The formation of a PSO in 2010 was a natural extension of my consulting activity and studies of clinical peer review practice, through which I uncovered a significant relationship between particular clinical peer review practices and better hospital performance on both subjective and objective measures of quality and safety. This work resulted in an evidence-based, best-practice model for peer review: the QI Model. It also revealed huge variation with respect to the use of these practices and equally large opportunity for overall program improvement. As a result, I have developed and continue to refine a suite of evidenced-based products and services to facilitate adoption of these best practices.

For hospitals, outpatient surgical centers and group practices, my firm's PSO services support efforts to create a culture of safety and learning by making it safe for clinicians to self-report cases for peer review, by establishing an effective, non-punitive clinical peer review process, and by bringing efficiency and effectiveness to peer review program management. All this can all be readily achieved with My PREPTM (the Do-It-Yourself option) or via The Peer Review Enhancement ProgramSM in combination with PREP-MSTM.

For other PSOs, QA to QI offers free group participation in the Normative Peer Review Database Project and the opportunity to sponsor an Ideal Peer Review Process Collaborative. The company also provides content for newsletters and produce educational programs customized to membership needs.

Ideal Peer Review Process Collaboratives will further enhance the evidence base on how best to achieve optimal peer review process, while strengthening organizational capability to learn from defects (see my whitepaper: A Framework for Patient Safety).

The Normative Peer Review Database Project was designed to establish the reference point from which to validate best practices and otherwise evaluate peer review program improvement efforts. It supports and advances the AHRQ Common Formats initiative. Participation is protected under the Patient Safety Act.


QA to QI will contribute to process improvements that demonstrably enhance healthcare quality and patient safety on a national level.


The firm's primary purpose is to conduct activities to improve quality and patient safety.

QA to QI will work with interested healthcare providers to facilitate improved quality and safety by offering a variety of products and services, including management consulting and patient safety organization services. It will seek opportunities to apply its unique expertise in the domain of clinical peer review practice to further advance knowledge and practice. In this effort, it will develop relationships with a variety of state and national organizations, as well as with other Patient Safety Organizations, to disseminate improvement information and recommendations.