Interdepartmental peer reviewBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7083.765 (Published 15 March 1997) Cite this as: BMJ 1997;314:765
Allows exchange of ideas about clinical practice and organisation
Peer review in clinical medicine is concerned with maintaining and enhancing the quality of health care. It does this through formal external assessment by peers of the structures, processes, and outcomes of health care for which standards are known or accepted. It is distinct from appraisal, a confidential process in which individuals' professional and performance development and job progress are reviewed against agreed objectives at regular intervals by an educational supervisor or clinical manager. It is usually applied to specific aspects of care or outcomes of a service but is equally applicable to an entire service or department. Several specialties are now introducing interdepartmental reviews, enabling doctors to share and exchange ideas on best clinical and organisational practice.
The British Thoracic Society introduced a system of voluntary interdepartmental review in 1992.1 This focuses on the organisational aspects of service provision and training, using the review as a forum for the exchange of ideas and experiences in subjects of particular interest or concern. The system grew out of a pilot scheme between units in East Anglia and Yorkshire2 and encompasses many features of the organisational audit of the King's Fund in London.
Units are visited by two reviewers from different regions, at least one of whom comes from a hospital of similar size. Before the review, basic data are collected on a detailed questionnaire. These include the population served; staffing levels; workload; inpatient, outpatient, and investigative facilities; provision for particular patient groups; and provision for training. This prepares the unit for the depth of the review and ensures that no time is wasted on collecting data when it could more profitably be spent focusing on particular subjects of interest or need and exchanging ideas.
The brief for reviewers is to assess the overall running of the unit during a two day visit, using published criteria where appropriate,3 4 5 6 7 8 9 10 11 12 13 14 and to produce a detailed confidential report. The report highlights strengths (to enhance local morale) and notes any perceived weaknesses, including a list of recommendations for change. That nearly a third of chest physicians in Britain volunteered for the 1992 reviews, and over 140 (again, about a third) have volunteered for the 1997 reviews, suggests that the scheme fulfils a need and is popular.
In 1992 the reviewers made 155 key recommendations for change in 21 units and drew attention to a further 165 adverse factors, of which 72% did not require substantial additional resources for implementation. Predictably, many of these were already appreciated by the reviewed units, but unanticipated recommendations were made in about half the reviews. Highlighting excellence in the reports undoubtedly boosted local morale.
Schemes such as this must be judged on results. Half of the key recommendations for change had been achieved or were imminent one year later, but, perhaps more importantly, 82% of the participants thought that they had gained new ideas during the reviews. All but two of the 86 participants found the exercise helpful and rewarding.
The organisation of healthcare delivery is a neglected area, and clinical practice is continuously evolving with the introduction of new treatments and new management strategies. This form of peer review offers a way of helping clinicians respond and contribute to these changes. In Britain it has the support of the Royal College of Physicians and the Department of Health. Other specialties, including cardiology, are developing similar schemes. With increasing demands for accountability in the NHS, periodic peer review of departments may become mandatory, and experience from voluntary schemes should help ensure that mandatory schemes are both effective and acceptable.
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