Does your medical staff have a comprehensive physician performance framework?

Patient Safety Quality Monthly

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October 15, 2006

Dear Colleague,

At the Greeley Peer Review for Today seminar in Chicago a few weeks ago, we tried something new. We asked participants to rate their peer review program using 20 best-practice criteria for peer review and submit the data anonymously before the start of the program. Each criteria was scored 0, 1, or 2 based on whether the practice was not performed, performed but inconsistent, or performed consistently. We then shared the data with participants early in the program and used it as a guide for focusing on what practical steps might move their programs to the next level. 

The 20 criteria were a subset of the structured self-assessment tool that The Greeley Company has used to evaluate over 70 hospitals in the last two years, representing the most problematic issues for medical staff peer review programs.

I would like you to consider the responses to one of the criteria relating to the attendees' physician performance frameworks. The specific criteria to be rated was the following statement:

The medical staff has adopted a clear, written framework that defines multiple aspects of quality physician performance (e.g. Technical Quality, Service, Resource Use, Patient Safety, Relationships, and Citizenship or JCAHO/ ACGME General Competencies).

Here were the results: 44% of participants had no framework, 44% had a partial framework, and only 12% had a comprehensive framework.

Why did we ask participants to rate their medical staff's frameworks? Over the past 10 years, we have educated physician leaders on the benefits of having a comprehensive framework as a means to set physician performance expectations and measure performance against those expectations. However, even though it was best practice, it was not a requirement to have a framework because peer review was still viewed by many as being focused predominately, if not exclusively, on the technical aspects of care.

However, with new 2007 JCAHO medical staff standards, it is no longer an option to have a comprehensive framework. What is still an option is which framework you choose to use with your medical staff.

The JCAHO has adopted the ACGME framework used for evaluating residency programs. It has six categories: Patient Care, Medical Knowledge, Practiced-Based Learning, Interpersonal Skills and Communication, Professionalism, and System-Based Practice.

Another option is the six-dimension framework described in the above criteria. The Greeley Company has taught this framework to many physician leaders over the past 10 years. It was derived from the ACPE, it is comprehensive, and it covers all of the same issues as the ACGME framework, merely organizing them in a way that many practicing physicians seem to understand.

We have developed a cross-walk between the two frameworks to demonstrate their equivalency, but there are good reasons for choosing either framework. The main issue is that, if you choose JCAHO accreditation, you now must have a comprehensive view of physician performance. And if you are not JCAHO accredited, it still is the best practice.  

So where is your medical staff on this issue? If you have a framework, make sure you can show how it covers all of the ACGME categories and that you are measuring all of its components. If you don't have a framework, your medical staff quality committee or MEC needs to get this on their agenda immediately, adopt a framework that works for your medical staff, and then determine what additional indicators you may need to measure all the dimensions of physician performance.

Regards,

Bob Marder, MD
Practice Director, Quality and Patient Safety
The Greeley Company

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