Problem Doctors

Is There a System-Level Solution?

Physician performance failures are not rare and pose threats to patient safety. While it is medicine's fiduciary responsibility to ensure the safety of the performance of colleagues, few hospitals respond to physician performance failures effectively. Hospitals need formal systems to monitor physician performance and to identify and correct shortcomings. This article explores better methods for measuring performance and suggests ways to expand programs for helping practitioners who are deficient.

Key Findings:

  • Few organizations systematically monitor physician performance or have formal programs to identify problem doctors.
  • The current ad hoc, informal, reactive approach should be replaced with a routine, formal, proactive system of monitoring that uses validated measures to focus on clinical and behavioral performance. The monitoring system should have three essential characteristics: it should be objective, fair, and responsive.
  • A model monitoring system could be created in four stages: adopting standards, requiring compliance, monitoring performance, and responding to deficiencies.
  • Implementing a model system requires a national effort that addresses developing better measures, expanding the number of physician assessment programs, and developing and supervising remediation programs.