The emphasis on process measures at Piedmont Healthcare carries forth to other aspects of quality, such as the peer review process, says Stephen Heimbigner, executive director for quality surveillance and analysis. Rather than a physician receiving a notification of a professional practices evaluation because of a bad outcome, a physician is reviewed because of poor performance related to a process measure, Heimbigner explains. Senior providers help coach their peers who are not following process measures. Leigh Hamby, MD, chief medical officer for Piedmont Healthcare and a surgeon, says the goal is to focus physicians on what will improve patient safety, not relying on luck that a patient did not acquire an infection, for example.

“If you don’t follow an order set for a colon surgery — even if you don’t have a colon infection, you’re going to get a friendly reminder from the peer review group saying, ‘We expect you to use the order set, and you were only at 80% compliance last month,’” Hamby says.

Piedmont Healthcare also measures the effectiveness of its peer review program. The health system standardized its peer review process so that it is handled the same way in every facility. Previously, the process varied considerably from one facility to the next, Heimbigner says.

The health system measures the success of its peer review process by the amount of peer coaching performed by providers, he says. That may range from a simple chat about a letter the doctor is about to receive, or a more formal intervention by colleagues related to an incident, trends, or process measures, Heimbigner says.

“Often, peer review is reactive, waiting for reports to come in from the field through variance reporting. But in the spirit of going after process measures, we know that we should utilize the EMR and find the times we are not compliant with the standard work,” he explains. “We look for opportunities to marry up the senior providers with the ones who are struggling in certain areas.”


  • Stephen Heimbigner, Executive Director, Quality Surveillance and Analysis, Piedmont Healthcare, Atlanta. Phone: (404) 372-7564. Email: