Background: Structured peer observation programs – in which clinicians observe one another and provide feedback – are potential mediators for spreading “best practices” and encouraging feedback among a group. Studies show hospitalist peer observation programs are feasible, perceived favorably by participants, and lead to improvements in self-reported assessments of teaching abilities. However, existing peer-observation models have two notable limitations: 1) few have addressed behaviors related to hospital operations (a critical skillset) and 2) few have assessed for longer-term behavioral changes.

Purpose: We sought to develop and evaluate an expanded peer observation and feedback program which included a focus on clinical operations as well as teaching skills. Clinical operations skills were defined as rounding techniques that improved patient flow.

Description: Hospital medicine faculty members at a single academic institution voluntarily enrolled (n = 34 of an eligible 44; participation rate 77%) in a structured peer observation program during the 2021-2022 academic year. Participants were randomly paired and each conducted a single observation of the other. Participants reviewed brief, asynchronous training materials prior to their observation sessions. During each session, the observing faculty member completed a real-time electronic survey to track both educational (including domains of “positive learning climate,” “patient-centered teaching,” and “trainee development”) and operational (including domains of “preparation for rounding session,” “workflow management,” and “advancement of patient care”) rounding practices of the hospitalist being observed. Following the 90 to 120-minute observation session, the faculty pair met for a structured debrief of the experience. At twelve months, program participants were surveyed to assess for durable changes in rounding behaviors.21 out of 34 participants (61%) responded to the post-observation survey. Three-quarters of respondents (16 of 21, 76%) tried to implement a new behavior they observed their partner performing during the observation activity. Nearly one half of these behaviors (7 of 16, 44%) related to operations activities, such as patient triage for team rounds, workflow flexibility, and incorporation of patient safety discussion into rounding.

Conclusions: An expanded peer observation program that incorporated an operations focus led to changes in practice that were durable over a 12-month period, with slightly less than half of behavioral changes related to clinical operations and the remainder related to teaching skills. These results suggest emphasizing operations-based behaviors can feasibly expand the scope of faculty observations. Given the low cost and administrative burden, this could serve as a model for improving hospitalist practice within groups. Further research is needed to assess outcomes of relevant inpatient metrics following program implementation.