Gaps in practice

January/February 2011

FocusGaps in practice

Peer review

A safety and quality improvement initiative in a general practice

Volume 40, No.1, January/February 2011 Pages 30-32

Angela Rutherford


A general practice in inner city Melbourne (Victoria), committed to ensuring quality standards of clinical care, developed a process for peer review of their doctors’ performance. The aim was to ensure that there was a robust and fair process for evaluation of doctor performance from both a safety point of view, and from the perspective of contribution to team based practice.


This article describes the process and outcomes of this appraisal process.


From the springboard of weekly clinical meetings which address critical incidents and near misses, the practice doctors developed an annual process of formal performance review incorporating hard and soft indicators of clinical performance and compliance with professional and practice standards. This type of activity falls within the scope of quality improvement in general practice

Since 2007, the author’s practice, a five doctor practice in inner city Melbourne (Victoria), has successfully run an in-house medical peer review program. This program arose out of a sense of imbalance at the practice. The reception and administration team were trained in the business of ensuring a good patient experience, and their performance was regularly reviewed by the practice manager. However, the doctors’ professional certification, which ensured their safety to practise, did nothing to ensure that they functioned as good team members and contributed to the overall patient experience and satisfactory operation of the business. In effect, doctors were treated differently. There was no internal review of their work, which involves a lot more than just their professional competence. It seemed sensible to ensure a mechanism was in place to troubleshoot problems at an early phase, and to provide a framework for remediation.

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