Is Sham Peer Review Real?
Sham peer review is, in a nutshell, inappropriate use of physician peer review as a weapon rather than as a quality improvement and risk mitigation tool. The first time I heard the term “sham peer review”, I took offense to it. The term seemed to be unfairly directed at all involved in peer review including physicians, attorneys, executives and staff who work with the utmost integrity to fulfill their professional responsibilities in providing the best care and protecting patients. The fact is that when used appropriately, peer review is among the very best quality improvement and risk mitigation tools we have. There is virtually no replacement for the process or the potential impacts that stem from high integrity, collegial peer review.
As my career evolved and I became increasingly focused on peer review, I immersed myself in the peer review efforts of hospitals in every state of every shape and size. I became less defensive when I heard the words “sham peer review” as I became more aware of how peer review is sometimes misused. My experiences compelled me to advocate for appropriate use of peer review, emphasizing that it should never be used as a weapon, a competitive strategy, or a way to carry out a vendetta against a physician who has fallen out of favor. Nor is it to be employed as a way of solving tangential problems that have little to do with patient care. Peer review’s purpose is, first and foremost, to improve care and reduce risk. It’s an analytical and educational tool, a learning opportunity that should be embraced by the entire organization. In the best cases, it’s an integral part of a healthy culture.
Does that mean peer review should never result in corrective action? If corrective action is needed to protect patients from dangers identified in peer review, then it must sometimes result in corrective action. But when corrective action ensues in the context of sham peer review, the sham often sticks out like a sore thumb. It’s not only wrong, but obvious.
There is, unfortunately, sham peer review. While I don’t think it’s all that common, I have seen firsthand how peer review is used to hurt people, to win a battle, to eliminate unrelated problems that are deemed too difficult to solve, to intimidate, or to expel from the organization those that go against the grain of the organization or who make too many waves.
Sham peer review is a real problem, but it can always be avoided. It starts with education, making sure that all involved in peer review are to be aware of the potential for peer review abuse. Then, all involved must be vigilant, constantly watching for red flags, including interpersonal undercurrents, conflicts of interest, and behaviors that are not reflective of the highest integrity. With awareness, critical accountability is possible.
Are your physician and executive leaders willing to hold each other accountable for any behavior that might be indicative of sham peer review? And are you taking advantage of all available the strategies to make sure your peer review processes and related decisions are defensible?
– Jon Moses, President & CEO