“Just Culture” and peer review: what you need to know

“Just Culture” and peer review: what you need to know

As nurses, it is our professional responsibility to monitor the quality of our nursing care, ensuring that the highest standards of nursing practice are followed. One way that we do this is through nursing peer review — the evaluation of our professional practice by nursing peers. According to the American Nurses Association, clinical peer review is practice-focused and fosters a continuous learning culture of patient safety and best practice.

As such, the Department of Nursing Quality and Research has developed and is now ready to test a nursing peer review process beginning in February.

Nursing peer review is based on the principles of a Just Culture model. A Just Culture engages in learning, designing safe systems, and creating an open, fair and just culture.

Just Culture improves patient safety by creating an environment of shared accountability — the healthcare organization is accountable for the systems they have designed and treats their staff in a fair and just manner, and staff are accountable for the quality of their choices and for calling attention to system vulnerabilities and their own errors.

Three behaviors we can expect in any culture are: human error, at-risk behavior, and reckless behavior. Each of these behaviors is managed differently in a Just Culture. The nursing peer review process will involve evaluating events, based on these human behaviors, and making recommendations for managing the event.

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We currently do not have a nursing peer review process; instead cases are managed in diverse ways, often by Clinical Directors and/or through the root cause analysis (RCA) process. Incorporating a nursing peer review process within our shared governance structure will allow us to:

identify learning opportunities
address system-wide issues aimed at improving the quality of patient care
increase professional accountability.

A  Nursing Staff Quality Review Committee (NSQRC) has been formed to conduct nursing peer review. This committee is comprised of staff nurses, nurse educators, and charge nurses from all four service lines in the hospital (Adult Acute Care and Critical Care, Surgical Services, Women’s and Children’s, Ambulatory).

In addition, a patient advisor serves on the committee, along with the Director of Nursing Quality, who serves as a non-voting facilitator. All committee members have received specialized training in Just Culture nursing peer review and have signed a confidentially agreement. The role of the committee will be to review selected cases using objective Just Culture tools to evaluate practice. Cases selected for review will include those that have resulted in harm to a patient or had the potential for harm. These cases will be selected from a variety of sources, including RCAs, calls from 4PTS, Clinical Director referrals, peer referrals, physician referrals, and patient-family referrals.

In the spring we will be providing you with an update on the new process. In the meantime, if you have any questions about our new peer review process, please contact Cathaleen Ley, Director of Nursing Quality and Research, at cley@aahs.org.

-Cathaleen Ley, PhD, RN

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