New NYC Health + Hospitals CMO on Why You Need Better Peer Reviews

There are several essential elements in effective clinician peer reviews, says Selwena R. Brewster, and you're probably missing the mark.

Hospitals should have robust peer review processes for clinicians, according to the new CMO of NYC Health + Hospitals/South Brooklyn Health.

Selwena R. Brewster, MD, MBA, became CMO and interim chief quality officer of the NYC Health + Hospitals campus that features Ruth Bader Ginsburg Hospital in September. Brewster's previous leadership roles include serving as associate CMO of NYC Health + Hospitals/King County.

Peer reviews are an essential part of hospital leadership, according to Brewster.

"The key to effective peer reviews is ensuring they are conducted well," Brewster says. "This can be achieved by equipping your teams with the right tools and guidance to perform meaningful reviews. A chief medical officer must actively educate their teams on the peer review process, helping them recognize its value and fostering excitement around the work. Additionally, a strong peer review committee within each medical department is essential for ensuring consistency and thoroughness."

There are several essential factors for conducting effective peer reviews.

"Key elements of an effective peer review process include establishing a clear timeline for completion, providing the peer review committee with a structured template to guide their assessment, implementing a grading system to evaluate cases, and offering tools like a spreadsheet to track the progress and outcomes of provider reviews," Brewster says.

Timeliness is crucial for peer reviews. At South Brooklyn Health, Brewster says, the goal is to conduct peer reviews within two weeks of an event.

Peer reviews should include a standard of work, Brewster explains.

"For instance, if an adverse event occurs in the emergency department and you need to review the provider's care, the goal is to determine whether the care met the established standard or did not," Brewster says. "It's crucial to have a template that guides the reviewer through the evaluation process. Templates help ensure consistency, making sure that all providers are held to the same high standard of care."

A peer review process also should be secure, according to Brewster.

"The provider who is being reviewed should feel safe," Brewster says. "Just as we prioritize the security of patient information, the same level of confidentiality should apply to peer reviews of clinicians. When a provider's case is under review, it should not be widely known within the department. There must be a level of privacy surrounding the peer review process."

Selwena R. Brewster, MD, MBA, is CMO and interim chief quality officer of NYC Health + Hospitals/South Brooklyn Health. Photo courtesy of NYC Health + Hospitals.

Throughput and Capacity Management Initiatives

Hospital throughput and capacity management initiatives can reduce length of stay, enhance operational efficiency, and improve care coordination, according to Brewster.

A key element for the success of these initiatives is the early identification of an estimated discharge date for patients.

"When a patient arrives in the emergency department and trusts us with their care, clinicians need to estimate how long the patient should remain in the hospital if they are to be admitted," Brewster says. "We need to assess the patient's condition and compare it to similar cases to determine the average length of stay for patients with that particular pathology."

Brewster emphasizes that determining an estimated discharge date should not follow a one-size-fits-all approach.

"Humans are not uniform—there are differences between patients," Brewster says. "However, starting with an estimated discharge date is crucial for effective throughput, capacity management, and reducing length of stay."

Effective throughput management not only boosts operational efficiency but also leads to better patient outcomes, Brewster adds.

"If throughput is managed properly and consistently monitored, it leads to better outcomes and fewer hospital-acquired infections," Brewster says. "Patients who spend less time in the emergency room or the hospital tend to have better outcomes."

Coordinating care effectively is also essential to successful throughput management, according to Brewster.

"This requires collaboration among multidisciplinary teams, including case management, social work, physicians, and nursing staff," Dr. Brewster says. "It's like an orchestra—everyone must play their part to ensure patients receive the highest quality of care."

Aligning Clinical Operations with Budgetary Goals

A hospital CMO must be aware of costs, quality, and throughput metrics to ensure that clinical operations align with budgetary goals.

"Our health system is moving toward a value-based care model, where the focus is not just on the number of patients seen but on the quality of care provided," Brewster says. "The finance team is working closely with the quality team and the medical staff. We are more aligned than ever because reimbursement for services depends on meeting quality metrics."

There must be close collaboration between the CMO and the finance team.

"As the CMO, I am fully transparent about clinical care with the financial team because strong collaboration is essential," Brewster says. "My primary goal is to provide the best possible care for our patients, which also supports financial sustainability in a value-based care system."

Data-driven decisions are vital to this collaboration, according to Brewster.

"To ensure our clinical operations are in sync with budgetary goals, I focus on key data points such as length of stay, reimbursement denials, and utilization management key performance indicators," Brewster says.