How Peer Learning Can Turn Errors into Improvements

Building strong individual and organizational support for a strong peer learning program can lead to real improvements in patient care, said several presenters on an RSNA 2020 panel.

Thursday's Controversy Session, "Peer Review and Peer Learning-Are We Just Meeting Requirements or Are We Really Improving Our Practices?," brought together radiologists and health care leaders to discuss the benefits of peer learning and how they implemented it at their institutions.

The session was moderated by Jay K. Pahade, MD, associate professor of radiology and biomedical imaging, vice-chair of quality and safety, radiology and biomedical imaging, Yale School of Medicine.

Creating a Culture to Learn from Mistakes

Broder

The first step to establishing a healthy peer learning program is to change the culture, said Jennifer C. Broder, MD, vice chair of quality and safety in the Department of Radiology at Lahey Hospital and Medical Center in Burlington, Massachusetts. Previous programs like Mortality and Morbidity conferences or peer review programs tied to physician performance evaluations may have set a negative tone. "We need to create a culture where fear and shame don't dictate our response to error, both as organizations and as individuals," she said.

During her session, "Changing the Culture of Your Practice to Foster Participation in Peer Learning," Dr. Broder emphasized the importance of a just culture — one that understands that even the most highly trained professionals make mistakes. A just culture does not avoid accountability but uses a consistent and structured approach for evaluating error where human error is consoled, at risk behavior is coached, and reckless behavior is disciplined.

"No one came to work with the goal of hurting anyone, but mistakes happen and then we experience shame, guilt, loss of confidence, concerns about our jobs," Dr. Broder said. "Given what is at stake, it's understandable that people would have significant reservations about bringing their mistakes to light. But, if all of our mistakes end up in a black box we have little opportunity to improve the quality and safety of the care we provide, and we risk repeating those mistakes again in the future."

Peer learning, she said, should be about identifying learning opportunities and sharing them in a way that provides feedback without judgement, which can build community and improve teamwork among radiologists.

Peer Review is Not the Only Way

Donnelly

Although peer review has become popular in recent years, Lane F. Donnelly, MD, chief quality officer and professor of radiology and pediatrics at Stanford Children's Health, said it is not actually a requirement under the Joint Commission, the Center for Medicare and Medicaid Services, the American Board of Radiology, or the American College of Radiology.

In his session, Dr. Donnelly explained that while the industry's regulatory agencies may require ongoing professional practice evaluation, they do not specify a peer review model as a requirement.

"There are not any regulatory or accreditation requirements that prohibit transitioning from peer review to peer learning," said Dr. Donnelly, who is also the co-executive director of Stanford Medicine's Center for Improvement.

For radiologists looking to convince their institutional leadership to make the switch, Dr. Donnelly said it is important to sequester activities that are aimed at improvement from those that are aimed at individual provider competence. "Peer learning is on the improvement side. We are evaluating events or errors solely on the basis of trying to improve our systems," he said.

Beyond Learning, Improving Outcomes

Sharpe

Once a healthy peer learning program is established and supported by radiologists and their institution, it's time to take the next step to actual improvements.

Richard Sharpe Jr., MD, MBA, a radiologist at Mayo Clinic in Arizona, presented "Case Studies: Examples of How Peer Review and Peer Learning Can Drive Practice Improvement" to detail several examples of how the peer learning program at his institution has added value.

For example, a woman undergoing breast cancer screening complained that it took 45 days to find out if she had cancer after seeking a screening appointment. The peer learning team then reviewed complaints about delays and learned that existing metrics only looked at screening volumes, not patient concerns. They created a patient-centered metric called "sleepless nights'' to measure the number of nights a patient is waiting for results. They then worked to eliminate the sources of delay and improved the average number of sleepless nights from 30 to 34 down to five or six.

Other projects eliminated health care waste, facilitated better communication between radiologists and physicians, and delivered better outcomes for patients.

"Peer learning enabled process improvements across a variety of domains in our practice and that's very exciting," Dr. Sharpe said.

Watch Jennifer Broder, MD, Richard Sharpe, Jr., MD, and Lane Donnelly, MD, discuss the ways that peer review and peer learning are helping radiology practices and departments improve patient safety through a just culture.

For More Information:

View the RSNA 2020 session Peer Review and Peer Learning-Are We Just Meeting Requirements or Are We Really Improving Our Practices? — SPSC50 at RSNA2020.RSNA.org.