Peer to Peer Review/Feedback

[blc00]

Looking for some input

I currently work in the ICU. We are under new management and management wants to start implementing a "Peer to Peer" review/feedback process. Management implemented their version of "Peer to Peer" on a med-surg unit, and now that she is in charge of the ICU, she wants to implement it here. Only thing is... it didn't work and quickly stopped once she left.

I offered to take charge of implementing the review/feedback process but am a little stuck on what to do/change given that neither me or my co-workers have worked in a hospital that did such a thing. My hopes is that I could explain the process we had in mind and get some feedback from some creative people or people who have seen something like this implemented in their hospital.

Here it goes:

There would be a committee of four nurses, made up of day shift and night shift. No charge nurses.

There would be a locked box that nurses could submit anonymous positive comments regarding a nurse's performance, patient safety concerns directly related to a nurse's care, or any other issues. The issues will be collected once a month and evaluated by the committee. The committee would then draft a letter to the people who received complaints/positive comments. For the complaints/issues the letter would explain the issue and how to correct it. In addition to drafting the letters, the committee will make a list of all of the complaints received that month with no names and provide them to the manager. This will allow the manager to get a general idea of what is going on in the unit so they stay informed.

These complaints/issues only go to the committee and the committee CANNOT discipline any employee as it is exclusively comprised of staff members. IF a person receives the same complaint twice then the issue gets brought to management.

The idea of the "Peer to Peer" is to provide an opportunity to bring issues to employees and allow the employee to self-correct undesirable behaviors before any formal disciplinary processes ensue.

According to management: "It is the objective of the Peer 2 Peer committee to enhance and encourage pride, accountability, and self-discipline among all of the team members. The Peer 2 Peer Committee was created to cultivate a workplace that has a commitment to excellence, a focus on customer service, and to bring to light how each person's actions impact the patient and co-workers. It is the goal that each team member will take a look at themselves and evaluate the concerns of the team and self-correct their behavior without the use of the disciplinary process. We must remember that we are here for the betterment of the patient and the patient's experience. While we are providing excellent patient care, we must not forget how our behaviors impact the patient, visitors, the nursing unit, and the hospital as a whole."

And that is it... I am nervous how this will impact the unit's culture and morale in the short term. But I do believe this could bring positive change in the long term (if used correctly).

Any idea on things to change/add?

If you have been apart of something like this: How did it work? Was the process different? If so, how?

I appreciate all feedback. I like the idea but I think there might be a better way of going about this... just now sure what that better way is.

Thanks!

[Wuzzie]

Yes, do not make it anonymous. This has a high likelihood of turning into a witch hunt. If somebody has an issue with a peer they should be adult enough to address it openly. Personally I think this is an awful idea that will destroy the morale of the unit. I would run from a job that had this in place.

[macawake, MSN]

I currently work in the ICU. We are under new management and management wants to start implementing a "Peer to Peer" review/feedback process. Management implemented their version of "Peer to Peer" on a med-surg unit, and now that she is in charge of the ICU, she wants to implement it here. Only thing is... it didn't work and quickly stopped once she left.

Honestly, I'm not suprised that it didn't work out.

OP, I realize that you came here looking for ideas about how to perhaps improve on the details of your proposed plan, and I'm afraid that my reply won't be very helpful in that regard. Regardless, I'd still like to share a few of my thoughts on the matter. I just want to be straight from the beginning and let you know that I don't believe that anonymous peer to peer reviewing is beneficial.

There would be a committee of four nurses, made up of day shift and night shift. No charge nurses.

There would be a locked box that nurses could submit anonymous positive comments regarding a nurse's performance, patient safety concerns directly related to a nurse's care, or any other issues. The issues will be collected once a month and evaluated by the committee.

I object to the anonymity, not the feedback. I believe in accountability. I admire persons who have the backbone to address another person directly, instead of going behind their backs. I want to encourage people to speak to one another, and to work out their disagreements as adults.

Looking at the complaints that nurses would be submitting in that "locked box". Seriously, what kind of complaints are important or serious enough that a nurse should take the time to single out a coworker and write something critical about them, but at the same time NOT more important than it can comfortably wait a full month before someone looks at it and even begins the process of addressing the issue?

The answer to that is petty stuff, and is in my opinion much better suited for direct communication when it occurs. If it's important enough to warrant a mention, you address it then and there. If it's not important enough, you forget about it.

And for crying out loud, if you see a coworker doing a good thing, TELL them. Writing an anonymous note so that four commitee members can write a letter about it sometime in the future seems so convoluted to me. What's wrong with talking directly to the people you work with?

The committee would then draft a letter to the people who received complaints/positive comments. For the complaints/issues the letter would explain the issue and how to correct it. In addition to drafting the letters, the committee will make a list of all of the complaints received that month with no names and provide them to the manager. This will allow the manager to get a general idea of what is going on in the unit so they stay informed.

These complaints/issues only go to the committee and the committee CANNOT discipline any employee as it is exclusively comprised of staff members. IF a person receives the same complaint twice then the issue gets brought to management.

So the four peers in the committee would be keeping some kind of "ledger" with some kind of work performance "debits and credits" recorded about every coworker? (Or perhaps it's just the debits that are to be tracked?)

Coworker A; praise x 2 and complaints x 1... Coworker B: praise x 0 and complaints x 5 etc.? How long would the record be kept, so that it can be tracked if the same person does in fact get the same complaint twice?

Not to be too rude, but the Stasi encouraged that type of behavior (keeping records of thy neighbor's behaviors), back in the day in East Germany.

Listen OP, I'm not accusing you of being the Stasi. I think you mean well. I just don't believe that this kind of thing will have the unicorns and rainbow effect, that your manager seems to believe. The quote below in my opinion illustrates that unrealistic unicorns and rainbows expectation:

According to management: "It is the objective of the Peer 2 Peer committee to enhance and encourage pride, accountability, and self-discipline among all of the team members. The Peer 2 Peer Committee was created to cultivate a workplace that has a commitment to excellence, a focus on customer service, and to bring to light how each person's actions impact the patient and co-workers. It is the goal that each team member will take a look at themselves and evaluate the concerns of the team and self-correct their behavior without the use of the disciplinary process. We must remember that we are here for the betterment of the patient and the patient's experience. While we are providing excellent patient care, we must not forget how our behaviors impact the patient, visitors, the nursing unit, and the hospital as a whole.

OP, how do you think it will affect workplace dynamics that there will be a group of four of you, who have all the "inside scoops" about which coworker is currently on the praise list and who's in trouble with a lot of anonymous complaints leveled against them? You will be in a position of power.

And how do you handle complaints against any of the four of you that end up in the locked box? Is it possible that you'll due to resentment, now become a target for complaints, since you now have a new and different role in your "hierarchy"?

The idea of the "Peer to Peer" is to provide an opportunity to bring issues to employees and allow the employee to self-correct undesirable behaviors before any formal disciplinary processes ensue.

Would formal disciplinary measures ever be taken, based solely on anonymous notes left in a locked box?

I sincerely hope that at some point in the process there'll be some transparency and actual accountability. Since I don't think you should or can base disciplinary action on anonymous complaints, I think you might just as well do away with that feature entirely.

The anonymous aspect in my opinion, provides an excellent opportunity for people who want to air their grievances, real or made up, without ever having to take responsibility for their words. They're given the opportunity to air their grievances not in public, but while remaining protected and hidden. And the accused doesn't get the chance to respond to and question their accuser.

And that is it... I am nervous how this will impact the unit's culture and morale in the short term. But I do believe this could bring positive change in the long term (if used correctly).

I think you're right to worry about the effect on morale.

If you have been apart of something like this: How did it work? Was the process different? If so, how?

I appreciate all feedback. I like the idea but I think there might be a better way of going about this... just now sure what that better way is.

Thanks!

OP out of curiosity, are you still working in the facility that posted about in February? You then wrote that your facility "has high levels of workplace bullying and/or incivility". If that's still the case, this anonymous peer-to-peer thing is probably a recipe for disaster.

It is probably abundantly clear by now, that I think the better way is to talk to people. Directly. To their faces.

If management wants a method to improve the unit, I suggest a "locked box" for suggestions that are not related to/concern individual employees, but rather to general workplace issues and that any people-to-people praise, feedback and complaints be handled directly by the parties it concerns, without creating artificial "intermediaries" or "messengers". To me creating a "middleman", only adds a layer of opaqueness and injects a possible (highly likely!) source of workplace friction, without contributing anything positive.

Best wishes!

[203bravo, MSN, APRN]

Let me guess -- either the new manger came from a Magnet hospital or your hospital is attempting to gain Magnet status... Peer review is a requirement for maintaining their status.

Regardless, the system that you are proposing takes the intent and purpose of what a peer review process is supposed to be and turns it into exactly what it's not designed for.

I would recommend that you either follow the guidelines as set forth per the American Nursing Association or scrap the idea.

1. A peer is someone of the same rank.The term "peer review" does not refer to an annual performance evaluation conducted by a manager. In true peer review, floor nurses review other floor nurses, advanced practice nurses review other APNs, and so forth.

2. Peer-review is practice-focused.

This means the process is concerned with patient outcomes. It's a way to monitor the standards of care within a unit, as measured against professional standards and evidence-based nursing practice.

3. Feedback is timely, routine, and continuous.

When peer review happens in real-time - rather than as an annual evaluation - nurses can catch policy and process failures right away and correct them, before more harm occurs.

4. Peer review fosters a culture of continuous learning regarding patient safety and best practices.

Peer review is not a blame game. Its purpose is to gather evidence that can be used as the basis for policies and procedures that improve nursing care on an organizational basis.

5. Feedback is not anonymous.

In order for nurses to work together collaboratively, we need face-to-face, professional dialogue about nursing practice, rather than sharp criticisms or personal attacks.

6. Feedback considers the developmental stage of each nurse.

Nursing skills develop along a continuum, from novice to expert. This brings into play another important consideration - the chance for experienced nurses to act as informal mentors to younger nurses, by sharing supportive insights or practical ways to apply critical thinking skills.

[blc00]

Let me guess -- either the new manger came from a Magnet hospital or your hospital is attempting to gain Magnet status... Peer review is a requirement for maintaining their status.

.....and a light bulb just went off. Slow to turn on, but it's on now. Thanks!

[EDNURSE20, BSN]

I agree. This sounds awful. If someone has an issue with another rn it should be addressed straight away. Where things can be openly discussed and sorted.

There's always two sides of the story and only hearing one side and then sending a letter to the person and management could end in disaster. Especially if bullying is involved, this makes it easy for people to do so. Because there feedback is always consider correct and the other person is always wrong.

This isn't going to build a positive culture on your unit.

I have heard of peer review for appraisals. Where another person monitors a person for a little bit and writes an appraisal for them. Generally looking a good things. But if there are issues they can be brought up. But it is a once a year thing and people know who is monitoring them.

[ICU-BSN]

I didn't have time to read other comments so it's possible someone already pointed this out....

All events have three sides...nurse A, nurse B, and the truth somewhere in the middle. I would be kind of ticked to get a letter of counseling without ever getting to tell my side of the event.

[blc00]

Thank you soooo much for your thoughtful response. Truly. The peer to peer thing has always seemed impossible/difficult to get right but I am trying to think positive and trust management has their best intentions.

I do agree that having the complaints made anonymously opens up the door to a ton of potential problems. But in our unit we have a culture that won't provide constructive criticism and instead lets the issue simmer and bad mouths each other to other nurses and even doctors. This might be why management suggested it be anonymous. And the only reason why praising was introduced into the mix was because they were worried it would be too much negative. Plus, if someone sees that you got a letter from the committee then they would know it was negative. So if praising is allowed then it would (hopefully) prevent the negative connotation with receiving a letter.

how do you think it will affect workplace dynamics that there will be a group of four of you, who have all the "inside scoops" about which coworker is currently on the praise list and who's in trouble with a lot of anonymous complaints leveled against them? You will be in a position of power.

this is a great point and an unintended consequence of this program. but you are 100% right. how can it truly be "peer to peer" when the other has "power" and know of all your wrong doings?

Would formal disciplinary measures ever be taken, based solely on anonymous notes left in a locked box?

I truly don't know how management would handle this. But I would assume the union would not allow a nurse to be punished based on anonymous complaints.

...are you still working in the facility that posted about in February? You then wrote that your facility "has high levels of workplace bullying and/or incivility"...

The answer is yes, I am still working at the facility with the bullying issue. I will say, a few of the main "bullies" have left and the problem is slightly better. I would like to say they left partly due to clashing with the new management. But who knows.

Over all I think I am very naive and lost in regards on how to change the culture and morale in the unit. I came from an ER at a large teaching hospital where the atmosphere was wonderful to work in and miss it. Now working in my first ICU I'm stunned by the stark difference. Really hoping this is not just an ICU thing.

Thanks again! And thanks for the recommendations!

[JKL33]

Looking at the complaints that nurses would be submitting in that "locked box". Seriously, what kind of complaints are important or serious enough that a nurse should take the time to single out a coworker and write something critical about them, but at the same time NOT more important than it can comfortably wait a full month before someone looks at it and even begins the process of addressing the issue?

This is exactly the problem. Either there's a real issue that needs to be addressed in a timely manner, or there's pettiness - - and often not much in-between.

**

I think people considering P2P feed-back ideas should ask themselves what the desired outcome is. In the situation you're considering, OP, not everyone is even participating, KWIM? The people who are really loved and really disliked may get some feedback - what about everybody else? The people who are encouragers and the people who are complainers will submit items to your box - what about everybody else? The proposed idea also doesn't guarantee any constructive criticism for those who most often do things well, nor any positive feedback for those who often struggle. It doesn't necessarily mean that the criticizers get their own feed-back, either.

I wouldn't love this, but I would appropriately participate in something like being matched with one other person (month at a time, maybe, then shuffle) where we must share a positive thing or two and a critique or two with our partner, and receive our partner's feedback about our performance as well.

Mostly, though, I think that trying to create an atmosphere where safety and performance is improved through the use of real-time feedback from peers is always going to be problematic when that is made the focus rather than focusing on fostering excellent, respectful relationships in general.

When respectful relationships are demonstrated and encouraged, people are free to give genuine feed-back, and free to receive feed-back genuinely.

No one learns to receive critiques by being criticized.

[Been there,done that, ASN, RN]

"Management implemented their version of "Peer to Peer" on a med-surg unit, and now that she is in charge of the ICU, she wants to implement it here. Only thing is... it didn't work and quickly stopped once she left."

If it didn't "work" on med-surg, it's REALLY not going to work in ICU. Must wonder why you would volunteer for a previously failed process.

[City-Girl]

I experienced Peer Review as part of an annual performance review at one of my previous employers. It seemed like a popularity contest and as much as I respected my nurse colleagues, as a majority woman driven field there was a fair amount of petty complaints made about some of the nurses that had nothing to do with their practice, but more on their personality. It seemed like an unfair assessment. If an individual nurse is having issues, a nurse manager is usually well aware of this without a formal process. I am more of a proponent of the self assessment used in combination of the nurse manager's evaluation of her individual staff members. Where I currently work, the self assessment includes accomplishments, areas for improvement, and goals for the following year. It causes the nurse completing it to provide truthful and complete feedback of their own performance.

[Emergent, RN]

We did it once. It caused a huge uproar, bad feelings and a breakdown of morale.