Establishing Effective Peer Learning Workflows

An ACR virtual program will help radiologists answer questions about establishing workflows for their peer learning programs.

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.”

New Year, New Priorities

Ongoing ACR efforts to stop radiology cuts associated with the implementation of the new CMS evaluation and management policy exemplify why members volunteer their time and resources to making the College strong and successful.

Welcome to our first Bulletin edition of 2021. While 2020 was certainly memorable and unique, we can all agree that we’d like for 2021 to be a little less dramatic.

In this month’s column, we will visit two issues. The first is the evaluation and management (E/M) revaluation. At the time of this writing, any legislative progress made during the lame duck session of Congress remains speculative. Government relations (GR) is one of the core competencies of the ACR. Our radiology community looks to the ACR for its advocacy leadership. Cynthia Moran, ACR executive vice president of government relations and health policy, deserves special recognition. We cannot thank her enough for her years of effort and expertise in establishing our GR team as one of the most respected medical professional advocacy groups in Washington. Our GR success is one reason our members have volunteered their time and invested in dues to make the ACR strong.

We have been dedicating every available resource to the E/M issue because of its wide-reaching and important impact on our practices and access to medical imaging for our patients. Remarkably, our GR team has been able to organize a coalition of more than 70 healthcare provider organizations to lobby for change in E/M revaluation implementation (learn more at acr.org/EM). This achievement cannot be overstated. It is unique in medicine to mobilize anywhere near this size of a coalition to act together for a common cause.

The ACR has also made a significant advocacy impact in Washington. Most notably, the College led an effort in the House of Representatives to gather 229 bipartisan
signatures on a letter urging House leadership to stop the impending E/M-based cuts. Encouraged by the letter’s tremendous support, the authors (Reps. Ami Bera, MD, D-Calif., and Larry Bucshon, MD, R-Ind.) introduced the legislation H.R. 8702, the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, to stop the E/M policy-related cuts — while maintaining its planned increases. Whatever the outcome might be of these congressional initiatives, ACR’s efforts will continue in earnest throughout the 2021 year.

The second issue we will visit is certification in radiology. The report from the ACR Task Force on Certification in Radiology was released on Nov. 18 at acr.org/Certification-Report. The Task Force was established in January 2019 in response to grassroots concerns about board certification and maintenance of certification. The ACR has a long-standing collaborative relationship with the ABR. Our priority is, and will always be, representing our membership.

The goals developed by the Task Force were to conduct environmental surveillance of options for certification, not only in medicine but in other professions; to gather data on what our members experience and expect from certification; and to develop recommendations going forward. Important concerns specific to the ABR, both real and perceived, were investigated. This effort was concurrent with the establishment of the Continuing Board Certification: Vision for the Future Commission by the American Board of Medical Specialties. The Task Force invested a tremendous number of volunteer and staff hours toward investigating, discovering, and developing recommendations. Thank you to both Eric B. Friedberg, MD, FACR. and Madelene C. Lewis, MD, for helping to spearhead this effort as chairs.

We all recognize that professional self-regulation through certification is critical to distinguishing ourselves as professionals. Rigorous criteria are demanded by the public and underscore our differentiation as medical imagers from other non-physician providers. As our practices migrate from peer review to peer learning, having our certification processes as part of, if not embedded in, the transition is a significant promise. The proposition of creating new expectations for our specialty through certification, such as data science fundamentals, could serve to advance our community together. Ambitiously, this could be launched not only on a domestic scale but on an international one as well.

On behalf of the College, we wish you and yours a healthy, successful, and safe New Year. We hope you enjoy your first 2021 issue of the Bulletin.