Testing a different type of peer review

If you were having a bad day at work that resulted in some unprofessional behavior, would you rather hear about it from your boss or a co-worker who understands the day-to-day stress of the job? Having those conversations with a contemporary—a trained peer messenger—was the basis of the Co-worker Observation Reporting System rolled out a decade ago by Vanderbilt University Medical Center. Applied first to physicians and advanced practice providers in the industry, the program has now been studied for its potential use to curb bad behavior by nurses and improve patient care quality.

Here’s how the program works: If someone witnesses a co-worker’s unprofessional behavior and there’s no conversation in the moment, the incident can be documented through an electronic reporting system. (The reporter is not identified.) A peer follows up with the employee to discuss the incident.

The program is meant to be nonpunitive, nonjudgmental and not part of a disciplinary action or an entry in a human resources file. Messengers selected for conversations are those who can best identify with the person. For instance, an emergency department nurse might be a peer messenger for a critical care nurse. Leaders are not brought in unless there is a persistent pattern.

During the study, which ran from September 2019 through August 2021 and involved about 6,700 nurses employed by University of Iowa Health Care, Keck Medicine of the University of Southern California and Vanderbilt University Medical Center, 95.5% of the nurses did not receive a report. Of the reports filed, almost half involved communication issues. Messengers are trained to acknowledge there are two sides to every story and to explain how someone’s actions are being perceived.

“It’s about allowing nurses to self-reflect and self-correct,” said Cynthia Baldwin, the study’s lead author and senior associate in Vanderbilt University Medical Center’s pediatrics department and school of nursing. “People pay attention to feedback from peers.”

Isn’t this like tattling, I asked Baldwin. A nurse I explained the program to had the same reaction, and noted that nurses on a unit know each other well enough to realize when one is having a bad day. It’s better to have those conversations in the moment, the nurse told me. Baldwin agrees, but noted those opportunities aren’t always available.

Peer-driven programs like this require buy-in from leaders, and given its success, Baldwin said researchers are exploring whether CORS could be applied elsewhere in healthcare.

“We know everyone doesn’t have a perfect day,” she said. “Giving everyone a chance or a break is what this program is about.”