Resource Library-Peer Review Best Practices: Getting the Most out of Practitioner Review Activities

Video Transcription

Video Summary

The session “Peer Review Best Practices,” led by Carol Gounad and anesthesiologist Michael Friedman, explains how peer review supports a healthcare competency framework, especially regulatory/accreditation requirements and quality accountability. Peer review is framed as balancing physicians’ autonomy and innovation with evidence-based standards and patient safety.<br /><br />They review peer review’s evolution: early roots in medical licensure boards in the late 1800s, a major expansion when the Joint Commission mandated peer review for accreditation in 1952, and a pivotal legal shift in 1986 with the Health Care Quality Improvement Act (HCQIA), which provided peer review immunity when due process is followed. The 1986 reforms also strengthened reporting via the National Practitioner Data Bank to prevent “state hopping.”<br /><br />Key best practices include building a fair, transparent system with updated bylaws, privileging documents, and well-designed governance structures; using appropriate specialty reviewers; disclosing conflicts of interest; and ensuring due process (notice, ability to respond, objective evaluation). They emphasize focusing on system failures rather than blaming individuals and using quality tools—checklists, charters, SBAR, control charts, histograms, cause-and-effect diagrams, benchmarking, zero-defect reviews, RCAs, credentialing summaries, and external reviews. They also highlight HIPAA allowances for peer review under healthcare operations and caution about bias and communication clarity.

Asset Caption

Speakers: Carole S. Guinane, RN, BSBA, MBA, CPHQ, FNAHQ, BBSS, Michael Freidman, MD, MAS

The purpose of peer review is to improve quality and patient safety, so it is evident that when assessing how to make strides in quality, we also evaluate peer review. Two experts in quality will walk through an example that examines how to determine the performance criteria, measures, benchmarks and data needed to support practitioner review activities. They’ll also discuss relationship building between administration and clinical staff, communication to break down silos, how to create efficiencies because of the changing landscape, and how to analyze data appropriately.

Meta Tag

Competency Tag QRA3

Competency Tag Description Facilitate physician and clinical provider performance review activities.

Domain Tag Quality Review and Accountability

Keywords

peer review best practices

healthcare competency framework

Joint Commission accreditation 1952

Health Care Quality Improvement Act (HCQIA) 1986

National Practitioner Data Bank reporting

due process and conflict of interest disclosure

quality improvement tools (RCA, SBAR, control charts)