An intervention model that promotes accountability: peer messengers and patient/family complaints.
A recent Australian study showed that a small number of doctors account for a disproportionate share of complaints by patients. These physicians are more likely to engage in disruptive behavior and be the subject of a malpractice lawsuit; however, system-level solutions for addressing poorly performing physicians are lacking. This study reports on the outcomes of a peer feedback and coaching program for physicians who had received multiple patient complaints and were therefore considered at high risk for malpractice lawsuits. This program, which was described in a 2009 AHRQ WebM&M interview, consists of a tiered approach that relies on feedback of patient complaints accompanied by one-on-one counseling by trained peer clinicians. Among more than 370 high-risk physicians who received coaching, nearly all responded professionally to the feedback, and almost two-thirds were considered to have responded appropriately to feedback over an average of 2 years of follow-up. Although disruptive and unprofessional behavior has long been tolerated in health care despite the safety risks, this innovative program demonstrates that this problem can be successfully addressed.