If you’ve paused to assess how well your hospital’s clinical peer review program conforms to the QI Model using the Self-Evaluation Utility and if you are not paralyzed by depression, you’re probably thinking about how to initiate changes. Even if you are depressed, take heart: you can overcome. Let’s explore how.
The overall project of adopting the QI Model involves the following key tasks:
These seven steps to peer review heaven might demand a circuitous route. That’s OK. The best path ultimately depends on organizational culture, politics, and personalities. The greatest challenge is typically found at the beginning and end.
So, start by using the QI Model score to communicate the improvement opportunity to others in your organization. Explain that your current dysfunctional peer review process is blocking the path to safety and quality by perpetuating a culture of blame and neglecting the role of systems factors in human error. If you meet with initial resistance, take it as a positive sign that people are being challenged to think it through. Not everyone gets a Pavlovian mouth-watering response at the mention of apple pie.
Still, after digesting your words, at least 10-20% of those you talk to will get it. They are your allies for change. Enlist their support. Ask for their advice as to how to proceed. If you don’t find immediate support for wholesale program restructuring, you’ll still likely find one department that is either already out front with a better process or that is willing to experiment. If so, work with that.
For example, the first time I took an organization through a redesign of peer review, the work sprang out of an innocent effort to solve a problem verbalized by one department chair. We took a blank sheet of paper and together sketched out a new process. We tested it in that one department. It was an instant winner! It wasn’t long before the medical staff leadership absorbed the impact and decided that all departments would need to adopt the new model. With other hospitals, I found equal success in getting support for a one-shot re-design. The end result was the same.
There is another possible approach that may interest you. Many organizations have become accustomed to using a collaborative process with like-minded institutions to catalyze change. For an overview of how this would work for peer review, see: Ideal Clinical Peer Review Process Collaborative. If there is sufficient interest, we can quickly organize a state-wide or regional collaborative for peer review program improvement. Contact me for more information.
With process design, the devil is in the details. In future columns, we’ll explore some of the top issues.
Marc T. Edwards, MD, MBA
President & CEO
QA to QI
An AHRQ Listed Patient Safety Organization