Peer Feedback, Learning, and Improvement: Answering the Call of the Institute of Medicine Report on Diagnostic Error
Peer Feedback, Learning, and Improvement: Answering the Call of the Institute of Medicine Report on Diagnostic Error
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DOI：
10.1148/radiol.2016161254
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发表时间：
2017-04-01
期刊：
影响因子：
19.7
通讯作者：
Kruskal, Jonathan B.
中科院分区：
文献类型：
--
作者：
Larson, David B.;Donnelly, Lane F.;Kruskal, Jonathan B.
2015年9月，医学研究所（IOM）发表了一份题为《改善医疗诊断》的报告，其中建议“医疗机构应采取政策和做法，促进非惩罚性文化，重视对诊断表现的公开讨论和反馈。“一份涉及医疗诊断等高度技术技能的报告将重点放在组织文化上，这似乎有悖常理。然而，当考虑到对人为错误以及个人和组织绩效的理解的最新进展时，这种智慧变得更加清晰。目前放射科医师绩效改进的主要模式是基于评分的同行评审，这反映了20世纪中期制造业的传统质量保证方法。我们发现，基于评分的同行评议往往会促使放射科医生向内发展，相互对抗，反对实践领导者，这远远没有实现IOM的目标，即庆祝成功，承认错误是学习的机会，促进开放和信任。现代质量改进方法的重点是利用和加强人际专业关系，以实现和保持高水平的个人和组织业绩。在这篇文章中，作者回顾了最近IOM报告提出的建议，讨论了其中几项建议的科学和理论基础，并评估了它们与当前放射学同行评审的主要方法的契合程度。作者还提供了同行评议的另一种方法：同行反馈，学习和改进（或更简洁地说，“同行学习”），他们认为这更符合IOM倡导的原则。(C)RSNA，2016
In September 2015, the Institute of Medicine (IOM) published a report titled "Improving Diagnosis in Health Care," in which it was recommended that " health care organizations should adopt policies and practices that promote a nonpunitive culture that values open discussion and feedback on diagnostic performance." It may seem counterintuitive that a report addressing a highly technical skill such as medical diagnosis would be focused on organizational culture. The wisdom becomes clearer, however, when examined in the light of recent advances in the understanding of human error and individual and organizational performance. The current dominant model for radiologist performance improvement is scoring-based peer review, which reflects a traditional quality assurance approach, derived from manufacturing in the mid-1900s. Far from achieving the goals of the IOM, which are celebrating success, recognizing mistakes as an opportunity to learn, and fostering openness and trust, we have found that scoring-based peer review tends to drive radiologists inward, against each other, and against practice leaders. Modern approaches to quality improvement focus on using and enhancing interpersonal professional relationships to achieve and maintain high levels of individual and organizational performance. In this article, the authors review the recommendations set forth by the recent IOM report, discuss the science and theory that underlie several of those recommendations, and assess how well they fit with the current dominant approach to radiology peer review. The authors also offer an alternative approach to peer review: peer feedback, learning, and improvement (or more succinctly, " peer learning"), which they believe is better aligned with the principles promoted by the IOM. (C) RSNA, 2016