QUESTION:
We recently had reasons to take a close look at how long it’s taking for cases to make their way through the peer review process and were surprised to see that it’s often more than seven months – even for issues that appear to be relatively straightforward.  Our peer review committee chair said that, frankly, the committee is drowning; there are so many cases going through that they discussed whether the committee should meet twice a month, but she’s afraid that will lead to a mass exodus in members.  She also said that, lately, they are spending so much time on behavioral issues that the clinical reviews seem like they are taking a backseat.  And when it comes to behavior, even those are dragging, often because it takes so long for the psychiatric evaluations that the committee asks for to come back.  Any suggestions?

ANSWER FROM HORTYSPRINGER ATTORNEY LEEANNE MITCHELL-OBRIEN:
Yes, several!  First, in terms of the process, consider having separate committees to manage clinical peer review, professional conduct and health rather than one that has to manage all three.  While they absolutely all fall under the umbrella of “peer review,” the issues require different types of expertise.  Specifically, clinical issues require clinical expertise – which should fall to a multidisciplinary peer review committee representative of the major specialties on the medical staff (and, depending on the size of the medical staff, could also include smaller, specialty-specific subcommittees that perform certain lower-level functions and then feed into the overarching peer review committee).

By comparison, professional conduct and practitioner health issues are challenging issues that require leadership expertise, not clinical expertise. For these issues, consider developing a smaller, more nimble committee that includes the key leaders on the medical staff – who are also the most seasoned and experienced in dealing with difficult issues (and people!).  Many medical staffs have the same committee (often referred to as a Leadership Council) deal with both of these issues – while others have a Leadership Council manage conduct and maintain a separate practitioner health committee.

You also noted that one thing slowing down the conduct reviews was waiting on psych evaluations to come back – and this is a great reason to make sure that you have fully separate policies addressing professional conduct and practitioner health.  The reality when it comes to unprofessional conduct is that while some conduct issues may be impacted by an underlying health issue, it is actually a very small percentage – and in most cases where health is the underlying cause, the indicator of a potential health issue is a change in behavior, not the existence of unprofessional conduct itself.

When unprofessional conduct continues despite lower-level leadership interventions, there is often a desire to identify a root cause that is more than just the need for behavior change by the practitioner at issue – which is a natural tendency of healthcare providers who spend their careers identifying and treating health issues (i.e., the “normal people don’t act this way” discussion that very often occurs in committees when discussing repetitive behavior issues).  When that type of sentiment is the sole basis for the shift towards a possible health issue (i.e., as compared to a noticeable behavior change or awareness of a difficult issue occurring in a practitioner’s personal life or practice life), committees often require psychiatric evaluations, which tend to result in non-helpful information that can actually sidetrack addressing the behavior at hand (i.e., narcissistic personality disorder diagnoses, etc.).

Redirection from a conduct review to a health review tends to shift the focus away from the specific unprofessional conduct that is at issue – which must change regardless of the underlying origin.  Overall, separate policies with fully separate review processes help to keep the focus on the unprofessional conduct; however, because it is certainly a possibility that health issue could be at the heart of a conduct review, there should be a reference in the conduct policy that would permit shifting a review out of the conduct policy and into the practitioner health policy.

If you have a quick question about this, e-mail us at info@hortyspringer.com.