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!

[Ruby Vee, BSN]

I fail to see how anonymous complaints are going to do anything positive for morale.

If you see a colleague doing something that requires negative feedback, be an adult and give them the feedback as kindly as possible. If you aren't brave enough to give the feedback yourself, allow your manager to give it -- but not anonymously. Own your words.

Anything else is going to turn into a petty popularity contest.

[Sour Lemon]

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!

Even in situations where only positive comments are allowed, this type of thing doesn't go well. I can only imagine what a train wreck it's going to be with negative ones.

[Mergirlc, MSN, APRN, NP]

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

^^^^^^

THIS. Don't do it. You'll always be remembered as that @#$*!@* that backed up that awful plan. The lackey of management.

[Sue Damonas, BSN]

I agree, it's definitely a bad idea. We did peer reviews when I worked in the hospital and there sure was a lot of pettiness. Definitely worsened the morale that was already low.

[Oldmahubbard]

I worked in HH many years ago. It was a small agency and a very pleasant place to work. Then the agency grew, and a dozen nurses came in from acute care, who thought they were better than the rest of us.

In those days we did a whole bunch of diabetic wound care in the home. Never sterile. No sterile supplies. Very basic instructions from the doctor's office.

Before long, people were slinging accusations about the validity of various aseptic techniques within the home, openly accusing others of incompetence. Some nurses boiled the scissors, some wiped them down with alcohol, some washed them with soap and hot water.

It became a witch hunt that tore apart the agency, and more than one person's career.

When doctors' offices' were eventually contacted, the standards for asepsis within the home were quite low. It was all smoke and mirrors.

As a result, I left nursing. Sure, I am still an APRN, but I am no longer involved in any of this bullcrap.

I have seen the vicious snakes that were ready and waiting for me, and they were in all cases stupid cowards.

This was 20 years ago. I ran into someone not long ago, and the genius made no eye contact.

Living well has been the best revenge.

[TriciaJ, RN]

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.

Don't make this a woman thing. I've worked in a male-dominated workplace and you wouldn't believe how much pettiness there was. There will always be petty people. Management either fosters this, or nips it in the bud. It is by no means a gender thing.

[peachtreednurse, RN]

Peer to Peer Review in my opinion is an ongoing process in nursing and is as frequent as same shift when reporting to charge nurse and shift to shift in primary care nursing, and does not require a lock box. Certain performance issues as covering a reddened IV insertion site/sometimes even leaking, with tape leaving it for the oncoming shift does become noticable after repeated occurrences, as not calling physician, in timely manner, for condition changes and/or change order requests, delaying new admission assessments, and various other poor practice methods and infractions, as many of us have become personally aware.

My documentation always reflected the condition, observation time, and action and any follow-up reader from fellow nurses, residents, attendings, case managers became aware.

Nursing is one profession that should require less policing and more conscientious behavior of any that come to mind, but with what seems to be a less and less personal commitment it may be an erroneous conclusion. It would be far better to have unit meting with voiced concerns and suggests to improv, rather than OP's desire to introduce this P2P review as policy.

[Buckeye.nurse]

We have yearly peer to peer evaluations as part of our performance evaluation. There's a few key differences from the format currently being suggested on your unit that are worth pointing out.

1) Our reviews are

---

not anonymous. As many others have pointed out, negative feedback quickly grows out of hand when it can be done anonymously. Why do you think there is so much cyber bullying? When people can hide behind an online handle the gloves come off.

2) The feedback is structured into a survey monkey. Our administrative assistant randomly chooses 3 peers to send our review survey too, and then we get 3 nurses to review. The survey focuses on core performance areas, as well as areas the unit is focusing on (such as CLABSI bundles, etc.). There is an area at the bottom to write 3 areas of strength, and 3 opportunities for improvement. Many of us struggle to find 3 opportunities for improvement and resort to suggestions like pursuing clinical ladder or becoming a charge nurse.

3) There is no middle man. The surveys go directly to our nurse manager. She reviews the surveys, and then incorporates the results with our own self assessment and her review. She then sits down with us for 20-30 minutes to talk about the past year and come up with goals for the upcoming year.

I'm with everyone else who said that a locked box on the unit will only erode morale. I wish you luck in navigating this tricky situation.

[Alex_RN, BSN]

I worked in a non-healthcare setting where we had something very similar. It worked beautifully because we all hated the idea so much, that everyone just faked everything in a positive light. Nothing substantive was ever documented. Managers gave tips on how to game the process and not make waves.

It was considered such a success, that people came in to study us. I was a new-hire and entry level, so I just sat there quietly with my eyes bugged out while the managers lied and said how great it worked. I imagine this is how a lot of pseudo-scientific stuff gets validity in the business world.

[canoehead, BSN, RN]

I was peer reviewed a few times. I picked three coworkers, and my manager picked three to fill out the evaluation form and turn it in. The day I went over it with my manager I asked about one of the comments, and she didn't know what it meant either. She put onto my permanent record a comment that was unintelligible! My impression was that it saves our managers from coming up with comments on their own, because frankly, they rarely see us, let alone observe our nursing skills.

Negative comments are tough, because if you need clarification on how to improve, no one knows...the reviewer is not there in the meeting. I didn't find the process helpful, even when I agreed that I needed to work on something, because I needed more information on how I was slipping up in the process.

[dec2007]

Honestly, I've been through this process, and it ends up being a lot of drama and a popularity contest, but not much help towards improving patient care or staff relations.

[Nurse Beth, MSN]

This is like playing with fire.