title: An intervention model that promotes accountability: peer messengers and patient/family complaints.
abstract: BACKGROUND
  Patients and their families are well positioned to partner with health care organizations to help identify unsafe and dissatisfying behaviors and performance. A peer messenger process was designed by the Center for Professional and Patient Advocacy at Vanderbilt University Medical Center (Nashville, Tennessee) to address "high-risk" physicians identified through analysis of unsolicited patient complaints, a proxy for risk of lawsuits.
  
  
  METHODS
  This retrospective, descriptive study used peer messenger debriefing results from data-driven interventions at 16 geographically disparate community (n = 7) and academic (n = 9) medical centers in the United States. Some 178 physicians served as peer messengers, conducting interventions from 2005, through 2009 on 373 physicians identified as high risk.
  
  
  RESULTS
  Most (97%) of the high-risk physicians received the feedback professionally, and 64% were "Responders." Responders' risk scores improved at least 15%, where Nonresponders' scores worsened (17%) or remained unchanged (19%) (p < or = .001). Responders were more often physicians practicing in medicine and surgery than emergency medicine physicians, had longer organizational tenures, and engaged in lengthier first-time intervention meetings with messengers. Years to achieve responder status correlated positively with initial communication-related complaints (r = .32, p < .001), but all complaint categories were equally likely to change over time.
  
  
  CONCLUSIONS
  Peer messengers, recognized by leaders and appropriately supported with ongoing training, high-quality data, and evidence of positive outcomes, are willing to intervene with colleagues over an extended period of time. The physician peer messenger process reduces patient complaints and is adaptable to addressing unnecessary variation in other quality/safety metrics.
authors.affiliation: Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee, USA. jim.pichert@vanderbilt.edu
authors.forename: James W
authors.initials: JW
authors.lastname: Pichert
authors.forename: Ilene N
authors.initials: IN
authors.lastname: Moore
authors.forename: Jan
authors.initials: J
authors.lastname: Karrass
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Jay
authors.forename: Margaret W
authors.initials: MW
authors.lastname: Westlake
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Catron
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Hickson
mesh_terms: D001364:Awareness; D003142:Communication; D005246:Feedback; D005260:Female; D006298:Health Services Administration; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D008297:Male; D008511:Medicine; D017060:Patient Satisfaction; D010379:Peer Group; D010817:Physician-Patient Relations; D010820:Physicians; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States