Research demonstrates that data-informed, peer-based interventions enhances understanding of the patient experience, improves self-regulation, and reduces medical malpractice amongst physicians. To that end, the PARS® program works with clients to identify disruptive behavior and conduct annual, peer-based interventions for each at-risk physician.
Preparation for Interventions
The most effective interventions are conducted with a foundation of institutional and leadership support. Physicians who have undergone the intervention process are reassured when they realize that the process has the support of key members of the medical staff and hospital administration, that the process is confidential, evidence-based and supported by a variety of sources, and that they are being invited to participate in the development of a better culture within the institution.
To that end, prior to conducting interventions, we assist clients in the establishment of the institutional infrastructure. This includes:
- Gaining full support from leadership and administration throughout the institution
- Establishing a Patient Complaint Monitoring Committee under peer-review guidelines
- Creating standards of Best Practice for rates of complaint capture, accurate recording of patient experiences, and physician identification within patient accounts
- Assessment of the institution's ability to record and transfer data to and from the PARS team
Level 1: Awareness Interventions
Interventions are conducted on a three-tiered basis: a Level 1 Awareness, or Level 2 Authority Guided, or Level 3 Administrative interventions. Level 1 interventions simply involve making individuals aware of their personal complaint profiles compared with those of their peers, asking those individuals to review the data-driven materials and consider devising a plan, and continuing ongoing assessments. All subsequent decisions regarding the nature and duration of any interventions are up to the Patient Complaint Monitoring Committee, and they are implemented in a manner consistent with each institution's governing policies and procedures. In general, for any given Level 1 situation, the Committee Chair may decide to:
- Do nothing except continue routine analysis
- Ask for additional data; and/or
- Recommend that a particular committee member initiate an intervention. At a minimum, that Committee member will be asked to:
- Review existing data regarding that physician and their practice
- Meet with the physician and share his/her Patient Complaint Profile.
- Ask the physician to develop a plan.
CPPA's experience with nearly 1,000 Level 1 interventions reveals that the vast majority of physicians willingly participate and respond favorably to reduce the number of concerns associated with their practice, in turn reducing their potential risk for medical malpractice.
Level 2: Authority Guided Interventions
Despite everyone's efforts, a physician may fail to respond to Level 1 interventions and continue exhibiting high-risk behavior. In such cases, the Committee considers invoking a more intensive Level 2 Authority Guided intervention. This intervention may include:
- Involving the chief of staff in a 3-way conversation about the nature of the problem
- With the chief's encouragement, requiring participation in a CME program or other appropriate course or counseling program
- Pairing the at-risk physician with a role model or professional coach
- Referral to a Physician Wellness Program
- Intensive practice evaluation to identify failures of systems of care
Level 3: Administrative Interventions
While we would like to think the previously described steps will be enough to promote higher quality behavior and patient care in most health professionals, a very small number may require very intensive Level 3 Administrative intervention steps that the Committee may invoke if necessary:
- Make referrals for psychological or psychiatric evaluation and, if needed, therapy
- Consider initiating the process that might lead to increased malpractice premiums for the department
- Revocation of selected privileges and, possibly, termination of privileges.