Question of the Week

Question: We have recently revamped our peer review process, eliminated our Department Peer Review Committees and instituted a Multi-Specialty Peer Review Committee.  The first few meetings of the multi-specialty committee have left us feeling like we are spinning our wheels.  Because no one on the committee is very familiar with the cases that have been referred for review, much of the meeting is spent trying to figure out exactly what occurred in the case or with questions to which no one on the committee has answers.  Most meetings end with the matters being tabled or held over until the next meeting.  Can you help us get this on track?

Answer:  First, congratulations on instituting a Multi-Specialty Peer Review Committee (or, using Joint Commission terminology, Professional Practice Evaluation Committee (PPEC)).  In our work with hospitals and Medical Staffs all over the country, we have found a multi-specialty committee to be the foundation for an effective process.  The issue you are encountering is not unique and can be addressed fairly easily.

Most PPECs do not include Department Chairs – and for good reason.  Department Chairs typically serve on the Medical Executive Committee – the only committee with disciplinary authority.  To emphasize to all practitioners that the peer review process is intended to be educational and helpful – not punitive – it is important to keep a bright line between the peer review process and the disciplinary process.  Thus, Department Chairs who serve on the MEC should not also sit on the PPEC.  In addition, an important role of the PPEC is to serve as a check and balance – reviewing the determinations and interventions made in the professional practice evaluation process by Department Chairs.  That check and balance function doesn’t work if the Department Chairs sit on the PPEC.

The downside to not having Department Chairs sit on the PPEC is that, often, they are the individuals who are most familiar with the cases under review.  Typically, they have either done the initial review of the case personally or assigned it to someone else in the Department with the appropriate clinical expertise to evaluate the care provided and, based on that review, determined the most appropriate intervention to address any identified concerns or to refer the matter to the PPEC.

To make the PPEC’s review more effective and efficient then, consider having either Department Chairs or the assigned reviewers who conducted the initial review present the cases to the PPEC and answer questions, but not participate in the deliberations of the PPEC.  Another option is to have the member of the PPEC who is in the same specialty review the case with the Department Chair or assigned reviewer prior to the PPEC meeting and then present it to the PPEC.

For a crash course on creating an effective peer review process, join Paul Verardi and Phil Zarone for The Peer Review Clinic.