1. PDSA and Peer Review Theories

2.  Plan, Do, Study, Act
 Used for continuous
improvement
 As it is a cycle it
requires constant
changes to the
ongoing process
Diagram taken from
http://www.iso9001consultant.com.
au/PDCA.html

3.  Plan: Recognize the need for change and
plan it.
 Do: Test the change initiative by carrying out
a small-scale study.
 Study: Review the study, the results and
identify what you have found.
 Act. Take action based on the above: If it was
not successful, redo the cycle focusing on a
different area. If it was successful, incorporate
what you learned to plan new
improvements, and begin the cycle again.
Adapted from the American Society for Quality’s Project Planning and
Implementing Tools paper.

4.  “Plan-do-study-act cycles as an instrument for
improvement of compliance with infection control
measures in care of patients after cardiothoracic
surgery”
Van
Tiela, F.H., Elenbaasb, T.W.O., Voskuilenc, B.M.A.
M., Herczega, J., Verheggend, F.W., Mochtarb, B.,
& Stobberingh, E.E. (2006). Journal of Hospital
Infection, 62,(1).

6.  Plan:
 1. Identify potentially modifiable risk factors for wound infections in patients after
 cardiothoracic surgery.
 2. Develop a pragmatic strategy to modify or prevent the occurrence of these risk factors.
 Do:
 1. Collect baseline data, e.g. rates of compliance regarding the chosen indices of
 correct procedure (baseline measurement).
 2. Carry out the planned intervention
 strategy.
 3. Collect basic data, e.g. rates of compliance
 regarding the chosen indices of correct procedure (follow-up measurement).
 Study:
 1. Analyse data.
 2. Summarize the results.
 3. Identify problems in the implementation
 of the designed intervention.
 Act:
 1. Determine the overall success or failure of
 the intervention.
 2. Identify potential modifications to
 improve the intervention strategy.
 3. Update the intervention with solutions for
 the identified problems.
 4. Prepare for the next PDSA cycle.

7.  Theshort answer is
“Yes”, although
continuous monitoring
would need to be
implemented, possibly
through peer reviews,
and further education.
Clipart taken from:
http://www.istockphoto.com/stock-
illustration-6514236-clipboard-list.php

8.  Failing to complete the STUDY and ACT
step
 Failing to complete the whole cycle
 Completing the plan but not implementing
it.

9.  Peer review is
synonymous with, but
not limited to,
retrospective medical
record review.
 Among other methods,
cases are identified
through generic
screens for adverse
events.
 Peer review is
conducted in
committees.

10.  Medical Peer Review:
 negligence and misconduct issues
>Nursing peer review

11.  “The Health Care Quality Improvement Act of 1986 is, ostensibly,
meant to protect the public from incompetent physicians by allowing
those physicians on peer review committees to communicate in an
open and honest environment and thus weed out incompetent
physicians, without the specter of a retaliatory lawsuit by the
reviewed physician. However, the consequences of the Act have
instead helped promote an environment that protects those
physicians on a peer review committee when they distort the review
process for their own gain, by maliciously disciplining those
physicians that may be in political or economic competition.”
Hall, B.J. (2011). The Health Care Quality Improvement Act of 1986 and Physician
Peer Reviews: Success or Failure? Retrieved from:
http://www.usd.edu/elderlaw/student_papers_f2003/health_care_quality_improvement
_act.htm

12.  No supervision
 “reasonable belief” standard
 No effective oversight of hospital peer
review proceedings to protect the
physician and ensure that peer review
decisions are evidence based.
 Possible inappropriate personal motives

13. According to Kinney, E.D. (2009).
 Rigorous adherence to established principles of
procedural due process in the design of peer review
proceedings that are eligible for HCQIA immunity.
 Establish higher standards for the evidence that must
be demonstrated to meet the “reasonable belief”
standard.
 Ensure that hospitals’ conduct of inappropriate peer
review proceedings are subject to consequences that
are effective deterrents to the abuse of peer review.
 Provide more effective oversight of hospital peer
review proceedings to ensure more accountability from
the hospital and participating physicians that peer
review proceedings are fair and accurate.

14.  Committees would need to be set up
 Greater accountability needs to be taken
by the hospital and the committee
 External committees
 Further trainings
 Non-compliance issues dealt with