Peer review of quality of care: methods and metrics

The privilege of professional self-regulation rests on clinical peer review, a long-established method for assuring quality of care, training, management and research. In clinical peer review, healthcare professionals evaluate each other's clinical performance. Based originally on the personal experience and expertise (and prejudices and biases) of one's peers, the process has gradually been formalised by the development of externally verifiable standards of practice, audit of care processes and outcomes and benchmarking of individual, group and organisational performance and patient outcomes. The spectrum of clinical peer review ranges from local quality improvement activities such as morbidity and mortality reviews, to medical opinion offered in courts of law. Peer review can therefore have different purposes ranging from collaborative reflective learning to identification of malpractice.