We perform quality management reviews for many of the top hospitals across the United States.
When we talk to risk managers and quality managers involved in these cases, one of the questions we commonly ask is, "How do you use the determinations that we provide to you? When we perform a hospital peer review, what do you do with the information? How do you integrate that information into a corrective action plan?" The fact is we get various answers from different people on this subject.
If necessary, some quality managers use our hospital peer reviews for disciplinary action with physicians who have engaged in things like misdiagnosis, mistreatment or outright provider fraud.
Other hospitals haven't integrated their peer review and their corrective action process to close the loop on these subjects.
Hospitals that have a disconnection between their peer review function and taking effective corrective action are missing a great opportunity to improve quality.
In fact, one of the things we ask ourselves is: "Why would they have us conduct a peer review if they don't plan to do anything with the information?" Because large organizations take on their own culture and politics, we believe that's one of the reasons why peer reviews aren't sometimes converted into corrective action.
If large hospital organizations scrutinized the work of one of their top physicians, it's very easy for them to avoid conflict arising from a discovery of wrong doing by that physician.
Many times it's easier to suppress these conflicts than it is to deal with them in a healthy, open and fair way.
This is one of the dilemmas for any large organization when it comes to self-policing and pressing for continuous improvement.
Certainly, it is one of the key issues that hospital organizations face with respect to improving quality management today.