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Peer review in a rural community hospital

1 August 2001


Peer review is the process by which clinicians evaluate and assist one another in better serving their patients. Essentially, there are five components of an effective traditional peer review process that must be in place for edification and learning to exist: I) direct observation of physician performance, 2) an effective case screening system, 3) a way to capture those cases that fail screening, 4) a definitive exception analysis at the clinical department level, and 5) an aggregation of individual events into a composite picture. At Northern Cochise Community Hospital (NCCI-J), this process may be in need of revision.

My project has two objectives: I) to evaluate the medical staff peer review process currently in place for the NCCH hospital providers and 2) to offer recommendations for improving that process, with the ultimate goal of resolving perceived problems. I will accomplish these objectives by first, discussing peer review in general, second, outlining the process as it exists at NCCH, third, explaining the process as it exists at other facilities, and finally, providing recommendations for improvement.

In order to understand peer review at NCCH, I interviewed 7 NCCH physicians, 3 hospital administrators, and I physician assistant. I solicited their personal definitions of peer review, their perceptions of the NCCH process, and their recommendations for improvement.

By far, the overwhelming majority of NCCH clinicians believe that the current peer review remains a negative process. The two most prevalent negative aspects are communication barriers and varied opinions on medical practices. Such negativity creates an atmosphere of contention, which blocks education and shuns quality improvement. In order to help identify other areas in need of improvement within the peer review process at NCCH, I visited 9 hospitals, impartial to this project, to solicit information and advice.

For the purposes of creating a more positive peer review experience, NCCH clinicians would like to see several short-term changes instituted. However, the long-term goals should be to focus on evidence-based medicine (EBM) and patient outcomes, encourage open reporting of medical error by providing immunity from legal discovery and non-punitive reporting approaches, and institute data standardization and interprovider analyses that might yield insights into methods to maximize patient safety and minimize error. Dr. Palmer Evans, a peer review expert, maintains that the future of peer review is in outcome studies performed in conjunction with the more traditional peer review process.


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