Why We Need to Do Peer Review Well
Patient Safety Quality Monthly
March 15, 2006
Dear Colleague,
This month's column is actually a speech by Dr. Michael McNamara given at a High Point Regional Health System at the quarterly medical staff meeting in January, 2006. Dr. McNamara is the incoming chair of the new medical staff peer review committee, which has been titled the Professional Improvement Committee. The peer review process had recently be redesigned as central multi-specialty committee using principles of the Greeley Physician Performance Pyramid that focus on improving physician performance, rather than the traditional "bad apples" approach. As the initial committee chairman, he was asked to acquaint the staff with the purpose of the reformulated committee. I found his presentation particularly articulate and compelling and asked if I might share his thoughts with my readers. Here are his remarks:
"For those of you who read the quarterly update, you know that our mission is to bring exceptional health care to the people of the area that we serve. I have some good news for you. We have already assembled and credentialed an exceptional medical staff at our hospital. Reflect on the many medical and surgical specialties that we represent. Think of how many thousands of hours of advanced training in residencies, fellowships, and continuing medical education that are part of the science of medicine that we bring to bear. Reflect on our collective experience of managing thousands of cases of acute and chronic care and the lives saved, the thousands of surgeries performed and suffering eased, and the thousands of new lives brought into the world with our hands. We are filled with the skills of the science of medicine.
And by training, choice, and inherent compassion we bring the art of medicine to the bedside of the ill and suffering. Our empathy, our patience, and our skill of listening speak to the art of our profession. I think that we do it well, and we honor the profession. We don't employ a trade. We administer with gifts.
We do well in the art and the science of medicine. But in the day to day practice of our skill, the profession of medicine, we may measure less well. Each of us brings with us to our medical duty and service the baggage of pressures each day. Lack of sleep, constraints of time to see more patients and make quicker judgments, the nagging pinch of diminishing reimbursements, demands on our time for the business of medicine grab an ugly hold. And many days we can not leave behind our personal worries be they financial, family, or failing health. Thus, there are days when each of us may function within our practice of medicine at a level that falls below what we expect of ourselves and of each other.
We as a medical staff have a duty to measure our own performance. Should we fail to faithfully carry this our, someone else will step in and assess and measure us. We have the responsibility to keep the scales and balances of professional assessment in house. I have been asked to chair the professional improvement committee. This is the committee tasked to carry the scales and balances - to measure the staff with a plan to continually improve our professionalism. This implementation may not be easy.
For those of you who feel that this committee is instituted to be critical, judgmental, and punitive, then I want you to know that my first job as chairman is to prove to you that you are wrong. This committee does receive, and will continue to receive written requests to evaluate aspects of patient care that someone (patient, family of patient, hospital staff: or your professional peers) have concern that the practice of the profession of the science and art of medicine failed their expectations, or failed their understanding of a perceived standard. We will ask you to give us information to enable us to make an evaluation. If there is no merit to the report, we will let you know. If there are system errors in this hospital that interfere with efficient professional practice, we will work to fix them. If you are a physician who through lack of sufficient training, personal arrogance, or honest error falls below the standard we hold ourselves to, then we will give encouragement and assistance, and if need be, outside intervention and training to help you lift your professionalism to better the collective us.
As I told the committee on our first meeting, we will succeed by that which we do not know. Our impact will be measured by the patient who does not die, the postoperative infection that never occurs, the length of stay outlier that goes home on time, and by being spared the blot of rancid community publicity for an event that never occurs.
We are an intelligent group of men and women with great gifts of knowledge, compassion, and service, and we are capable of change. We can change for the worse, or we can change for the better. I'm counting on the better. We will need your help."
The privilege society has granted us to have a self governing medical staff will only remain if medical staff leaders take on the responsibility of mutual accountability for physician performance that Dr. McNamara has so clearly articulated. If you would like to respond to Dr. McNamara, please contact us and we will forward your to correspondence on to him.
Regards,
Bob Marder, MD
Practice Director, Quality and Patient Safety
The Greeley Company
For more information on our Patient Safety and Quality consulting services, click here or contact Christine Beringer by e-mail, cberinger@greeley.com, or by phone at 888/749-3054, ext. 3174.
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