Peer Feedback, Learning, and Improvement: Answering the Call of the Institute of Medicine Report on Diagnostic Error

TLDR

The 2015 IOM report on improving diagnosis urges health‑care organizations to adopt nonpunitive, open‑discussion policies, shifting from traditional scoring‑based peer review toward culture‑focused quality improvement informed by human‑error research. This article reviews the IOM recommendations, examines their scientific basis, and evaluates how well they align with existing radiology peer‑review practices. The authors propose peer feedback, learning, and improvement—termed peer learning—as a more IOM‑aligned alternative to scoring‑based peer review. Their findings show that scoring‑based peer review drives radiologists inward, against each other and leaders, failing to meet the IOM’s goals of celebrating success, learning from mistakes, and fostering openness. © RSNA, 2016.

Abstract

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. © RSNA, 2016