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Unlike many hospitals that revamp their peer review processes to overcome sour medical staff politics, a punitive culture, and gross miscommunications, the two hospitals profiled in this case study simply wanted to weed out inefficiencies. With the help of The Greeley Company, the hospitals were able to streamline and standard­ize their peer review processes.

Client
Two hospitals – a teaching hospital with over 800 beds and a 400-bed hospital – that are part of seven-hospital system.

Case Study
Unlike many hospitals that revamp their peer review processes to overcome sour medical staff politics, a punitive culture, and gross miscommunications, the two hospitals profiled simply wanted to weed out inefficiencies. With the help of The Greeley Company, the hospitals were able to streamline and standard¬ize their peer review processes.

The 400-bed hospital started redesigning its peer review process years ago, and the results inspired medical staff leadership at the 800-bed hospital to follow suit two years later. Both hospitals kicked off their redesigns by eliminating the department-based peer review committees.

“Cases would go back and forth between departments with never really getting an answer. The resolution was often to create some new form or check box,” said one medical staff president about the hospital’s previous department-based peer review system. “It was incidental problem management, and it was really inefficient.”

The 400-bed hospital created a single multi-disciplinary peer review committee that it calls the physician excellence committee, while the 800-bed teaching hospital created two multi-disciplinary peer review committees: one for adult services and one for maternal and pediatric services. The new multi-disciplinary committees have taken the focus off individu¬als and placed it on improving processes and outcomes by adopting rate, rule, and review indicators.

“Physicians can make excellent decisions and have bad outcomes. Conversely, they can make horrible decisions and have positive outcomes,” says the medical staff president. “We’ve separated the outcome from the decisions that physicians made.”

The chief medical officer at the larger teaching hospital also notes that the previous peer review process was more subjective. As a result, physicians wondered why their cases were being reviewed when colleagues who had similar outcomes were not being reviewed. “Because there are now clear criteria, if there is a certain event and it falls into our threshold for review, it is reviewed. It eliminates the question of ‘why me?’” notes the chief medical officer.

These objective measures take into consideration a physician’s total number of patient encounters to judge whether that physician is experiencing a downward performance trend. Previously, a physician might have had a complication from surgery, but if that individual only did five surgeries per year, that case was treated no differently than a physician who did 200 surgeries a year, for example.

“If there was any part of this that scared people the most, it was the idea that a non-OB would be evaluating an OB’s decisions,” noted the medical staff president. To gain buy-in from medical staff members, the medical staff president went to departmental monthly meetings with case examples and explained that most of the time, the technical aspects of care are not what triggers the committee to review a case; rather, peer review focuses on whether the care plan for the patient was appropriate.

The president of the teaching hospital says that the new peer review system has led to deeper discussion among physicians about how to evaluate the care provided at both hospitals. “I feel like we finally have the forum to use this as an educational environment to improve care.”

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