News & Commentary

Peer Messengers Deliver On Doctor Improvement

The best way to help physicians improve is to let other physicians show them the way, according to a study in the Joint Commission Journal on Quality and Safety. “Peer messengers… appropriately supported with ongoing training, high-quality data, and evidence of positive outcomes, are willing to intervene with colleagues over an extended period of time,” the study states. “The physician peer messenger process reduces patient complaints....”

Those patient complaints are the foundation of the study “An Intervention Model That Promotes Accountability: Peer Messengers and Patient/Family Complaints.”

Complaints were used in this study to identify underperforming doctors. At a time when patients face more choice and greater financial burden, the researchers say, “Patients and their families are well positioned to partner with health care organizations to help identify unsafe and dissatisfying behaviors and performance.”

The complaints fell into to six categories: communication, concern for the patient, care and treatment, access and availability, environment, and billing.

The study, conducted by researchers at Vanderbilt University Medical Center from 2005 to 2009, involved training 178 physician messengers on the best ways to discuss problems with 373 peers who were considered at high risk of dissatisfactory or unsafe performance.

The physicians worked for seven academic and nine other medical centers in the United States. About 25,000 were either employed or associated in some other manner with the institutions.

The messenger physicians received eight hours of training on how to conduct interventions, emphasizing that messengers “share data in a respectful, nonpunitive, nonjudgmental, and nondirective fashion.”

Most of the high-risk physicians (97%) accepted the feedback in a professional manner, and 64% were what the researchers called responders, that is, physicians who improved by at least 15%. The doctors whose scores worsened (17%) or remained unchanged were called “nonresponders.”

“Responders were more often physicians practicing in medicine and surgery than emergency medicine physicians, had longer organizational tenures, and engaged in lengthier first-time intervention meetings with messengers,” the study states. The overall mean and median percentage of reductions in patient complaints were 50% and 80% respectively. Not surprisingly, perhaps, one of the motivations for changing was fear of being sued.

Though highlighting the study’s success, the authors also note that the problem might in fact be much worse because “many persons fear lodging a complaint about their physician’s practice” and “unsolicited complaints surely represent the tip of an iceberg that may be 20 to 50 times the number of reports.”


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