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Improving Hospital Safety, One Physician at a Time

By Lena J. Weiner  
   April 11, 2016

The Center for Patient and Professional Advocacy at Vanderbilt has spent two decades building a professional accountability model. Its director discusses how co-worker observations can be leveraged to promote greater accountability among physicians.

What happens when a lower-ranking healthcare worker observes bad behavior in a physician or another advanced practice professional?

In many organizations, that worker will keep the information to himself.

But that's not necessarily the case at Nashville-based Vanderbilt University Medical Center, says William Cooper, MD, director of the Vanderbilt Center for Patient and Professional Advocacy. He recently co-authored a study regarding peer feedback and physician behavior modification.

Published this month in The Joint Commission Journal on Quality and Patient Safety, it found that almost three quarters of clinicians confronted about bad behavior by a peer did not to be confronted again.

Establishing a culture that values safety is mandatory for a program like this to work, Cooper told me in a recent interview. "You have to have commitment to it, and it has to permeate the entire culture." The transcript below has been lightly edited.

HLM: Tell me a bit about the background of this study.

Cooper: The Center for Patient and Professional Advocacy has spent the last 20 years building a professional accountability model, which was originally created for identifying and intervening with physicians at risk of medical malpractice.

We began to recognize over the years that there are also ways physicians and other healthcare professionals interact with team members that might have an impact on key performance and quality.

Our malpractice work has used patient complaints as a source of [identifying] high-risk physicians. We know that 3% to 5% of physicians account for 45% to 50% of patient complaints. And, those same physicians account for 50% to 60% of medical malpractice risk.

But we hadn't had the chance to explore whether staff complaints were also non-randomly distributed. What we found was that in three years' worth of staff complaints, 3% of our physicians accounted for almost half of our staff complaints.


Lena J. Weiner is an associate editor at HealthLeaders Media.

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