FOR IMMEDIATE RELEASE (10/20/07)
Medical staff peer review is a ubiquitous and important activity for which there is virtually no comparative information.
Peer Review has long been one of the pivotal activities by which the medical profession has sought to protect the quality of patient care. Acute care hospitals, too, are wedded to the process in order to mitigate vicarious malpractice liability and comply with regulatory requirements. Surprisingly, no normative data has ever been published in the scientific literature regarding peer review program structure, process or governance. Overall, this subject has been neglected. In the last fifty years, only a handful of articles describe peer review programs as implemented in specific institutions.
Witnessing this dramatic gap in knowledge and the frustration of our colleagues who lack a reference point from which to think about improvements in their own programs, we decided to initiate this anonymous online survey with the hope of painting the first picture of medical staff peer review as it is actually done in hospitals across America.
The project is self-funded. Many organizations have made a non-financial contribution by e-mailing a notice about our survey to their membership.
We are conducting this research project without grant-funding or outside financial contributions. We gratefully acknowledge the support provided by the organizations that have recognized the importance of our work. They include Premier Inc., the University HealthSystem Consortium, the American College of Physician Executives, and hospital associations in Arkansas, California, Michigan, Missouri, South Carolina, and Wisconsin. These organizations have assisted us by inviting their membership to participate.
Responsible leaders in acute care hospitals affiliated with sponsoring organizations
Each of our partner organizations has a separate process for communicating with members. Some will reach out to a single individual at a given hospital. Some will send messages to three or more. In general, the following classes of hospital leaders are being invited to participate:
If you are considering participating, please help us by assuring that the individual with the most detailed working knowledge of your Peer Review Program’s operation assists in providing the answers to the survey items. While we’d like the highest possible response rate, we only want one response per facility! Consider notifying your associates of your intent to respond.
To complete the online survey
Our invitation to participate gives the hyperlink to the online survey. There are two potential complications: coordination and preparation
First, because of our unique sponsorship and the nature of various e-mail distribution lists, multiple people in each hospital may receive the invitation. Some may be solicited by more than one organization on our behalf. While we’d like a high response rate, we only want one response per facility. Thus, we are asking prospective participants to be pro-active in sorting this out based on the unique features of their organization.
We ask for best estimates of Peer Review program support staff FTEs, turn-around-time for review, reviewed cases as a percent of screened cases, the proportion of cases sent for external review, and case volume in relation to hospital volume. Many hospital leaders would love to have these benchmarks. Because these numbers are likely to be unknown or buried in many organizations, we alert respondents to do whatever research they might be inclined to do in advance. This is not obligatory. The survey makes it OK to choose the “Unknown” response option.
By design, the survey is anonymous. State associations will not know which of their member hospitals have participated unless respondents provide this information to them, independent of the survey. Such self-reporting will not compromise anonymity.
As soon as possible
We are fully committed to making our findings public. That’s the whole point of the survey! The complexity is that it might take about 6 months.
We are prohibited from “publishing” in advance of the scientific journal which accepts our article. Analysis of survey results and preparation of our manuscript will likely take several months. Then, from manuscript submission to publication could take another four months. JAMA, for example, averages 124 days for this process. In the interim, we may have the opportunity to present our unpublished findings at an appropriate scientific meeting.
To put this into perspective, even six months will not be a long delay considering we’ve gone more than 50 years with virtually no information!
We did several rounds of field-testing both the survey and our cover letter with hospital leaders (physician and non-physician) to assess face validity, time to complete, question ambiguity, etc. Also, we solicited feedback from all our prospective association partners, each of whom has some level of review process.
Hospital reviewers have uniformly given the survey strong endorsement. More than a few thought that completing the survey was an educational experience, as the questions gave them pause to consider aspects of their own programs that might be improved. The time to complete has been 10-12 minutes, exclusive of time that might be invested in researching program statistics in advance. None felt that the time required was excessive. Reviewer feedback has been incorporated into the survey design, including the addition of questions regarding reporting to Trustees and the organization of administrative support.
A few association staff raised a concern about the group of questions covering best estimates for Peer Review program support staff FTEs, turn-around-time for review, reviewed cases as a percent of screened cases, the proportion of cases sent for external review, and case volume in relation to hospital volume. Because these numbers are likely to be unknown or buried in many organizations, the worry was that embarrassment, frustration or similar emotional reaction might cause respondents to break off. We took this concern seriously. Nevertheless, given the recommendations of our hospital reviewers and knowing the value that these data would offer to hospital leaders, we decided to retain these items. Thus, we adopted a mitigation strategy: we included “Unknown” as a response option; and we changed the wording of the cover letter and the survey introductory page.
Evan M. Benjamin, MD, FACP, is Chief Quality Officer, Baystate Medical Center, Springfield, MA. He is also an Associate Professor of Medicine on the faculty of Tufts University School of Medicine.
Marc T. Edwards, MD, MBA, is a former hospital Chief Medical Officer who is currently the Principal of Wilson-Edwards Consulting, West Hartford, CT. Dr. Edwards does general work in healthcare quality and specializes in medical staff peer review program improvement.