For radiology departments striving to improve patient safety, transitioning from a peer review to a peer learning model may be key to creating a “just culture” of shared learning. A growing movement, the just culture workplace philosophy acknowledges that even experienced professionals make mistakes and provides an open and safe reporting system where all staff can speak up without fear of reprisal. From there, errors can be discussed as opportunities and systems, rather than people, evaluated for flaws. As some departments transition to a just culture, they find that they are in need of a different way of reviewing errors than what they have done in the past, a method which supports non-judgmental sharing of learning opportunities and supports teamwork.
“Peer learning eliminates scores attached to cases and creates a system where radiologists anonymously submit learning opportunities found in their peers’ work,” says Jennifer C. Broder, MD, vice chair for radiology quality and safety at Lahey Hospital and Medical Center in Burlington, Mass., and chair of the ACR’s newly-formed Peer Learning Committee. “We want to transform radiologists’ peer review processes into peer learning processes, which are collaborative and focused on learning.”
Identifying a Need
“Peer learning uses errors to create opportunities to learn instead of focusing on identifying and tracking errors,” says Regan City, PA-C, a healthcare quality and performance improvement specialist with Radiology Partners. “The approach requires an understanding of human performance and the importance of individual and organizational improvement, facilitating a culture of safety.”
City is a member of the Peer Learning Committee, which is hosting two webinar sessions in March, entitled “How to launch your peer learning program next week” (register for the March 18 session, happening at 12 p.m. ET, at bit.ly/PeerLearning1, or the the March 25 session, happening at 3 p.m. ET, at bit.ly/PeerLearning2). The idea for the webinar — co-chaired by City and Richard E. Sharpe Jr., MD, MBA, assistant professor of radiology at Mayo Clinic Arizona — came out of a breakout group session during the ACR Annual Conference on Quality and Safety in October.
“We heard from radiologists that they want to do peer learning, but they don’t know how to start,” says City. “They want the nuts and bolts — the operationalizing of peer learning, and what it looks like from start to finish.”
According to City, when a radiologist finds what they think is a learning opportunity on a study, they have to ask questions such as, “What did we learn from that experience?” and “How will we share that learning in our practice or in the wider community of radiologists?” She notes that the March webinar will showcase concrete, specific examples of how radiology practices can make the principles of peer learning operational.
We want to transform radiologists’ peer review processes into peer learning processes, which are collaborative and focused on learning.
Creating Programs in Practices
Sharpe points to a 2015 Institute of Medicine landmark report on improving diagnostic accuracy, which recommended that healthcare organizations establish a work system and culture that supports quality improvement measures in diagnostic performance. According to Sharpe, the collaborative processes that are key to peer learning programs are essential to improving patient care in complex healthcare systems — and what he hopes the March webinar will convey to ACR members. “We want to get radiologists excited to learn about how they can create and implement workflows to manage peer learning programs in their practices,” says Sharpe. “It eliminates the judgment and review aspect and allows for radiologists to be more relaxed with each other and grow together and collaborate.”
According to Sharpe, who is also a member of the Peer Learning Committee, practices need a mechanism to allow their radiologists to submit learning opportunities to a centralized location. “Before you can talk about learning together, you need to identify some cases in your practice that make for good conversations about growth opportunities,” he says. “Practices need a leader to review the submissions and create content for regular programming for the team so they can engage in these conversations.”
Sharpe notes that the March webinar will support radiologists in identifying learning opportunities in their clinical practice, identify submissions that have high learning potential, facilitate team discussions, and create an improvement strategy. “We’re also going to look at some of the technological solutions to support groups that want to do peer learning,” he says. “We want to talk about some of the gaps or challenges with current technologies or solutions that are impeding effective peer learning programs.”
According to City, the March webinar will be the first output of the new committee — and will bring actionable details of how radiologists can efficiently put together programs so conducting peer learning is not harder, but easier for them to do. “If the time is right for change, we want to facilitate radiology practices picking peer learning over the way they’re doing things now,” says City. “We all know it’s the right thing to do, but when it comes to actually doing it, the devil is in the details.”