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Review
. 2020 Dec 28;6(1):e375.
doi: 10.1097/pq9.0000000000000375. eCollection 2021 Jan-Feb.

Optimizing Professional Practice Evaluation to Enable a Nonpunitive Learning Health System Approach to Peer Review

Christy I Sandborg  1 , Gary E Hartman  2 , Felice Su  1 , Glyn Williams  3 , Beate Teufe  4 , Nina Wixson  4 , David B Larson  5 , Lane F Donnelly  1   4   5
Affiliations
Review

Optimizing Professional Practice Evaluation to Enable a Nonpunitive Learning Health System Approach to Peer Review

Christy I Sandborg et al. Pediatr Qual Saf. .

Abstract

Healthcare organizations are focused on 2 different and sometimes conflicting tasks; (1) accelerate the improvement of clinical care delivery and (2) collect provider-specific data to determine the competency of providers. We describe creating a process to meet both of these aims while maintaining a culture that fosters improvement and teamwork.

Methods: We created a new process to sequester activities related to learning and improvement from those focused on individual provider performance. We describe this process, including data on the number and type of cases reviewed and survey results of the participant's perception of the new process.

Results: In the new model, professional practice evaluation committees evaluate events purely to identify system issues and human factors related to medical decision-making, resulting in actional improvements. There are separate and sequestered processes that evaluate concerns around an individual provider's clinical competence or behavior. During the first 5 years of this process, 207 of 217 activities (99.5%) related to system issues rather than issues concerning individual provider competence or behavior. Participants perceived the new process as focused on identifying system errors (4.3/5), nonpunitive (4.2/5), an improvement (4.0/5), and helped with engagement in our system and contributed to wellness (4.0/5).

Conclusion: We believe this sequestered approach has enabled us to achieve both the oversight mandates to ensure provider competence while enabling a learning health systems approach to build the cultural aspects of trust and teamwork that are essential to driving continuous improvement in our system of care.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Diagram outlining the separation of the improvement from the individual provider competence portions of PPE. PPECs include Heart Center, General Pediatric and Medical Specialties, Pediatric Critical Care Medicine, Solid Organ Transplant, Surgical Specialties, Trauma, Obstetrics, Anesthesia, Neonatology, Pathology, and Radiology. MEC, Medical Executive Committee
Fig. 2.
Fig. 2.
Diagram outlining the flow of information gained about cases through various sources for PPE.
See this image and copyright information in PMC

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