The effectiveness of a peer review committee will be determined in large part by who is on the committee, says Bill Hopkins, JD, healthcare partner in the Austin, TX, office of Shackelford, Bowen, McKinley and Norton.

A peer review committee is an essential part of the overall quality assurance program of a facility. If used appropriately, this committee can be an excellent tool to evaluate patient care, identify systemic issues that may prevent good care, and weed out a problem professional.

“It is important for a facility to remember that a peer review process is only as good as the people who are administering it. Facilities must strive to ensure that there is comfort, professionalism, and trust in the peer review process. Otherwise, it will not be utilized. More importantly, if the process is deemed to be corrupt, there will be no credibility in participation in the process or the results derived,” Hopkins says. “To this end, an appropriate peer review process has to work to ensure that the appropriate types of professionals are appointed to the peer review committee. Sometimes, the demographics of the members is defined by state statute. Often, it is ... defined by the facility.”

The makeup of the committee is the first indication to the staff of whether the facility takes the peer review process seriously, Hopkins says. If the committee membership appears stacked or biased, the process will never be respected.

The committee membership must reflect a balance of diversity, expertise, and availability. If the committee is run well, it will produce great information. Staff will trust the process to improve the care provided in the facility. If the committee is not effective in achieving these goals, then an analysis must be performed to figure out why it is not working.

“Often, it is either the membership of the committee or the failure of the committee to strictly follow the requirements of the committee,” Hopkins explains. “If it appears that the committee does not follow the rules, there can be no confidence or assurances that the appropriate outcome will be achieved based on the facts.”

A quality leader’s role regarding peer review is to be a “good shepherd” to the organization, composition, and direction of the peer review “flock,” says Michael F. Ruggio, JD, partner with Nelson Mullins in Washington, DC. The peer review committee should be as small as possible, with diverse members focused on the integrity and transparency of the peer review process. Ruggio says quality leaders should use peer review committees to ensure validity of the care and the services provided, including careful research in cases. Valid care is safe care, which reduces risk for patients. Also, peer review committees can provide valuable feedback to the institution to help develop new rules or revise existing guidelines where needed.

“The quality leader needs to set up guidelines to ensure the peer review process is appropriate and that it requires review of situations that arise,” Ruggio says. “It should not be used as a tool for any internal or external political, personal, or other unwarranted scrutiny.”

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