title: Improving healthcare quality through organisational peer-to-peer assessment: lessons from the nuclear power industry.
abstract: Healthcare has made great efforts to reduce preventable patient harm, from externally driven regulations to internally driven professionalism. Regulation has driven the majority of efforts to date, and has a necessary place in establishing accountability and minimum standards.  Yet they need to be coupled with internally driven efforts. Among professional groups, internally-driven efforts that function as communities of learning and change social norms are highly effective tools to improve performance, yet these approaches are underdeveloped in healthcare. Healthcare can learn much from the nuclear power industry. The nuclear power industry formed the Institute of Nuclear Power Operators following the Three Mile Island accident to improve safety. That organization established a peer-to-peer assessment program to cross-share best practices, safety hazards, problems and actions that improved safety and operational performance. This commentary explores how a similar program could be expanded into healthcare. Healthcare needs a structured, clinician-led, industry-wide process to openly review, identify and mitigate hazards, and share best practices that ultimately improve patient safety. A healthcare version of the nuclear power program could supplement regulatory and other strategies currently used to improve quality and patient safety.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine, 1909 Thames Street, 2nd floor, Baltimore, MD 21231, USA. ppronovo@jhmi.edu
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Hudson
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D055848:Nuclear Power Plants; D019982:Organizational Case Studies; D011366:Professional Review Organizations; D011787:Quality of Health Care; D012922:Social Change