Improving healthcare quality through organisational peer-to-peer assessment: lessons from the nuclear power industry

Abstract

Healthcare has made great efforts to reduce preventable patient harm, from externally driven regulations to internally driven professionalism. Regulation has driven the majority of efforts to date, and has a necessary place in establishing accountability and minimum standards. Yet they need to be coupled with internally driven efforts. Among professional groups, internally-driven efforts that function as communities of learning and change social norms are highly effective tools to improve performance, yet these approaches are underdeveloped in healthcare. Healthcare can learn much from the nuclear power industry. The nuclear power industry formed the Institute of Nuclear Power Operators following the Three Mile Island accident to improve safety. That organization established a peer-to-peer assessment program to cross-share best practices, safety hazards, problems and actions that improved safety and operational performance. This commentary explores how a similar program could be expanded into healthcare. Healthcare needs a structured, clinician-led, industry-wide process to openly review, identify and mitigate hazards, and share best practices that ultimately improve patient safety. A healthcare version of the nuclear power program could supplement regulatory and other strategies currently used to improve quality and patient safety.

Beyond Measurement and Reward: Methods of Motivating Quality Improvement and Accountability

“…Among professional groups, internally driven efforts that function as communities of learning and change social norms are highly effective tools to improve performance, but are not well developed in health care. The approach has been dubbed “communitarian regulation” (Pronovost and Hudson ).…”

“…Among professional groups, internally driven efforts that function as communities of learning and change social norms are highly effective tools to improve performance, but are not well developed in health care. The approach has been dubbed "communitarian regulation" (Pronovost and Hudson 2012). Berenson, Pronovost, and Krumholz (2013) call for a more strategic use of measures by Medicare and other payers to address important problems.…”

The Clinical Area Safety Assessment, a Peer Review of Safety across an Acute Trust

“…Pronovost recently discussed how the widespread application of a process similar to the peer-to-peer assessment programme currently used in the nuclear industry should be considered in order to identify safety hazards and share best practice in terms of improving safety and operational performance between different hospitals [18] . We are unaware of other hospitals using team-to-team peer review in an effort to improve safety although organisational peer review has been used to improve the care of patients with chronic obstructive lung disease [19] .…”

Changing the narratives for patient safety

“…Highly qualified and experienced technical experts perform the reviews, making them more likely to identify best practices and to be meaningful. 16 A fourth step would be to engage academic institutions in low-and middle-income countries to build capacity for improving safety and quality in these countries. The model of global partnerships for global solidarity on quality and safety has already begun a new narrative, whereby human interaction across continents can drive change towards safety and quality of universal health coverage.…”