The role of peer review in improving hospital quality

Overview

Policies that rely upon information on hospital quality to drive quality improvement have their limitations. Only a limited number of quality dimensions of a local health service can be measured and monitored at once. Consequently, non-measured hospital performance objectives can be undermined by increasing effort in areas where quality can be measured, at the expense of quality in the areas where it cannot. This can lead to an unbalanced assessment of the quality of a hospital’s services. The consequences of such an “unbalanced scorecard” are stark; the crisis at Mid-Staffs highlights such an example where a policy to provide information, in part to drive quality, created a “tick box” culture that missed the point of continuous quality improvement.

One way of addressing the problem of an “unbalanced scorecard” is the introduction of peer review to enable a more balanced picture of quality to be drawn. The coalition government has promised an NHS “information revolution” and peer review may help to facilitate the interpretation of information shortcomings, and allow “soft” information to be incorporated into the assessment of a provider’s performance.

What we’re doing

We have commissioned the Centre for Health Service Economics and Organisation to explore and cost options for implementing peer review into hospital services. The research will focus on three main questions:

• What should be reviewed?
• How should it be reviewed? and
• Who should review it? 

Why we’re doing it

We are interested in understanding whether a new model of peer review can improve quality by facilitating choice through its role in shaping and assessment performance information. By exploring the role of peer review in assessing the entire patient pathway we are also keen to understand whether it can also act as a driver for more integrated care.    

Peer review could fit well with the existing regulatory framework, particularly if it can be established as being cost-effective; indeed, the NHS Next Stage Review Final Report recommended supporting clinicians and clinical directors to develop their practice through the process of peer review. By broadening the evidence base and bringing professionals into centre stage, peer review could have the potential to raise quality across the spectrum of performance.

How we’re doing it

This technical investigation adopts a mixed methodological approach and has four aims:

• to conduct a literature and policy review to explore potential implementation strategies for peer review and to begin to clarify the strengths and weaknesses of different strategies;
• to develop frameworks of potential peer review approaches for hospitals and how they ensure that appropriate care is delivered working alongside other actors along the patient pathway;
• to conduct a consultation with managers, specialists and clinicians regarding: 
  • the ways of implementing peer review in hospitals that are considered most likely to yield patient value; and
  • their previous experiences with peer review, and the lessons that these experiences provide
• to produce guideline costing for the leading models of peer review identified for assessing and driving quality in hospitals.

When will the findings be available?

Autumn 2012

For further information please contact:

Darshan Patel, Research and Development Manager