Peer Review Process - Essay Example

Peer Review Process The peer review process is a process that allows the critique of research papers by fellow colleagues in the same field. Apart from this it allows for credentialing of organization and companies allowing people to earn jobs, learn about the organization, and recognize its contribution towards its designated field of study. This paper looks at the peer review process at Cancer Treatment Centers of America and the ways in which it is similar to other organizations. It then looks at ways in which it can be improved. It finally looks at the way the process can be used in credentialing organizations, ensuring quality health care and how it helps nurses acquire jobs in organizations such as Cancer Treatment Centers of America. Peer Review Process When in the world of research, many articles are written and the way that they are clarified is through peer review. This is the process by which people of similar understanding in the same field evaluate the work done by their colleague before it is published. This is a form of self-regulation of research and studies in designated fields to maintain standards of quality, increase performance and grant credibility within the said field. Once the peer review process is complete, the reviewed material is then published or deemed worthy of teaching, presenting or enacting. This paper will thus look at the peer review process implemented at the Cancer Treatment Centers of America, compare it with that at American Academy of Nurse, and suggest improvements or changes. It will also identify the ways in which the process is used in the credentialing organizations, ensuring quality and improve advances in practice. To begin with, we will look at the Cancer Treatment Center of America. The Cancer Treatment Centers of America (CTCA) are a private for-profit institution that builds hospitals that are dedicated to the treatment of cancer and provides outpatient clinics in which patients can receive both traditional and complimentary alternative medicine treatments (Kent, 2014). With a head office in Schaumburg, Illinois, it has five fully-fledged hospitals around the United States in Illinois, Oklahoma, Pennsylvania, Arizona, and Georgia. It also has an outpatient oncology clinic located in Seattle, Washington. Having been founded by Richard J Stephenson in the late 1980s after losing his mother to cancer, the organization has been helping patients fight cancer using advanced technology and a personalized approach offering comprehensive cancer care in all its hospitals. Being an organization that is dedicated to the treatment of cancer, it has specialist who is always doing research in order to improve the quality and methods of treatments they offer. These are published in different journals after peer review processes that are conducted within the organization Based on the definition of peer review, it is also clear that it does not necessarily have to be performed on research or articles written. This process can also be done to the staff to evaluate their way of work. It can be used to evaluate, examine, make rulings, and provide feedback to peers after collection and review of the results and comparing them to the standard (Kent, 2014). Being a cancer and medical institute, it shares the same peer review process as that of the National Cancer Institute (NIC) and the American Academy of Nurse Practitioners (AANP). Through the peer review process, articles on research, studies and advancements, are critiqued, verified and subsequently published to offer credible information to those that need I in their field. The process goes as follows (Kent, 2014). Peer Review Process The first task is defining how the peer review process will be included in the professional practice model of the organization. Should it be a part of the performance evaluation process, should it be used in an educational or consultative manner after the official review process or should it be used as an element of a quality improvement project by the organization? In addition, they have to determine whether it will be a staff or article review. In this case, it will be a staff review. According to AANP, the majority of nurses, even when in support of the peer review, express distress about the participation of their peers official performance review that influences salary and promotion status. Therefore, it is essential to come up with a system that will be generally accepted by the personnel. One organization was able to come up with a system that used the three characteristics of peer review. For every four months, chart audits are compiled and the results are considered as one of the key aspects of an employee’s annual performance evaluation. On top of that, the quarterly peer reviewing provides continuous education and consultation concerning performance. They are also one of the key aspects of the general performance reviews that are held yearly. Another way to tackle it is by designing a stepped program that moves with gradual step-by-step implementation from learning to a review focus. Then again, one can approach it by at first assigning little or no credence to the peer feedback on the result of the annual performance review tally, with an intention of raising this importance as the employee’s expertise and reliance on the process increase. CTCA opted to at first use peer review to get hold of responses on only a single aspect of performance. They focused on customer service and satisfaction since the founder was not pleased with the help offered to his mother during her treatment (Sheahan, Simpson & Rayens, 2001). Designing Structure & Process The design of the structure and process for a peer review program is a difficult job. It is very important that sufficient time and resources are given to this crucial part. Decisions that are to be made involve what components of performance should be included as part of the review and how it shall be observed and recorded. Other crucial decisions are centered round the following: Who shall conduct peer review How many employees shall provide feedback How the reviewers shall be chosen The anonymity of reviewers or their direct involvement in providing feedback The schedule used in the collection and sharing of generating feedback This design phase also address the issue of time and resource management and its allocation in both staff training and providing them with enough time to comfortably finish the peer reviews, without feeling the limitation of patient care during the process. Education Plan After the completion of the design process, the next task is to develop an education plan. This is to help in the operationalization the process. The education plan should entail the fundamentals of the program, including an explanation and demonstration as well as the expected beneficial outcomes of it. As much as it is important that the program is successful, it is also important to design an educational plan that covers the skills required to conduct the peer reviews effectively. These skills include Observational methods Effective listening Information on objective performance review Approaches to be used in giving and receiving feedback and constructive criticism Confrontational techniques. Individual tales as well as role playing are helpful techniques for instruction in some of these crucial skills. Because its implementation has been presented in the framework of a significant culture change in the organization, it also is suggested that important managers and employee be trained in smoothing the progress of the change process. Piloting & Implementation When it comes to the implementation of the program, a pilot unit is recommended. Even with matriculate planning and intensive employee training, a detailed evaluation of the whole process from design to implementation is reasonable and acceptable before performing a whole organizational implementation. Staff opinion regarding their level of comfort with the experience as well as the alleged benefits should be collected. A common problem involves concerns about the individual who shall conduct the review including: Whether the reviewers are solely chosen by management? If the reviewers work close enough the peer or not? Have they been provided sufficient time to adequately perform and document the review? A common outcome usually involves peer feedback that is more subjective rather than objective or one that is more entirely positive or entirely negative. In addition, an issue that may arise is the employee’s reluctance to give feedback until anonymity is issued or offered. The standards which performance is put against for the peer review process may be regarded to be unsuitable. Modifications to the process and structure after this should be considered based on employee feedback prior to complete implementation. A continuous evaluation process is necessary for continued revision and refinement of the program after total implementation. Apart from conducting an evaluation of the process itself, it is recommended that an evaluation of the predictable outcomes is also carried out. A successful peer review program in the end is expected to strengthen the cohesion of any team and advance professional growth and accountability. Other than this, items such as documentation conformity, faults, staff and patient satisfaction, and nurse retention may be expected to improve as well as a result of the peer review. It is clear from the above that the process of peer review has been a complex task yet it is performed on a regular basis in order to maintain the standards of the organization. With a few changes in some areas, the process can be made into a better one faced with fewer perils. To begin with, the organization needs to handle the issues of employees fearing their fellow workmates. As discussed, the majority of those participating in the review process are concerned with the relationship that they as the reviewed have with the reviewer. This is both on a personal and official capacity. They fear that the nature of their relationship with influence the results of the review. Similarly, those charged with the task of organizing the review have difficulties. They have a hard time selecting the right person who will be able to conduct the review with uttermost competence. They also consider the he level of interaction between the reviewer and the one being reviewed. To deal with this issue permanently, CTCA should hire a specialist who will be able to review the employees unbiased. This is because; he does not have a prior relationship with any of the employee’s that will be reviewed and because he is also a specialist in the same field, he will be able to judge and understand the work situation. Furthermore, the workers will free to be handled by the stranger because with no prior history shared between them, they can make well informed decision on the topic. This will give the organizers more accurate feedback and in a shorter time since there will be pleasantries exchanged between the interviewer and the interviewee. Other than the introduction of an outsider into the process, the frequency of the reviews should be lowered. Being involved in a business in which technology and services are ever constantly changing, they are forced to keep up to date and thus are also ever adjusting their products, services, and treatments to fit the market and be at par with patients’ expectation. Because of the quarterly system of reviews, the machines, products, and services pass the employees without them having the chase to properly implement and incorporate them in their work. Thus, with reduced number of reviews they have more time to work with new products and treatments meeting patient expectation and also allowing them to be ready for the review since they will now have the required knowledge unlike before. For articles, studies and research papers a different model is used to perform the review process. Here, a single researcher or a group, performs a study and documents their methods, results and findings. After doing this the following steps are taken 1. Sending out the manuscript: Here one takes into consideration the journal that is best suited for the written manuscript. CTCA has partnered with several journals, thus providing its employees with adequate opportunities for the manuscript to get a chance for review. 2. Submission: This is the process of sending in multiple copies of the manuscript along with a cover letter in which a brief summary of the manuscript is included along with the basis of the research, processing fees which are sometimes waved depending on the journals and a self-addressed post-card that enable the journal to acknowledge receipt on your paper 3. Waiting: One waits as the editors and reviewers work on the article 4. 1st response: This is usually received between 2-8 months of submission. It is most likely a rejection based on statistics, but can range from a. Revise and resubmit b. Conditional acceptance c. Acceptance One usually receives an editorial letter multiple reviews with comments from the reviewers, but without knowledge of the disposition give to the editor. 5. If given the chance to revise and resubmit the manuscript, one is tasked with a heavy responsibility in making it achieve the standards stipulated by the reviewers. Generally, one’s goal is to send back the manuscript within six months with the appropriate changes but without rushing the revision. 6. Resubmission: This is sending back the revised manuscript along with a letter explaining the ways and means used to deal with the reviewers remarks. 7. Waiting: This may take another several months with the revised manuscript being returned to at least one original reviewer and at least one new reviewer. 8. 2nd response: If accepted and there are still minor corrections you want to make or accepted on condition that you make some adjustments, this is the time that this must be done. After which the final copy is sent back to the editorial team. 9. Confirmation: the journal will send you a letter informing you of its acceptance of the manuscript and the day that it will be published. They will also send you copy-edited versions for proof reading and once returned it is typeset to conform to the journal standard. 10. Printing: After the type-setting, proofreading and copy-editing the journal prints your article and you wait for the reviews to come in on the subject with support and criticisms that one accepts and readily defends against. 11. If the paper was rejected at some point in the process, one uses the reviews and comments to prepare the manuscript for presentation in another journal. Keep in mind that top journals, general and specialty, have a rejection rate of approximately 85-90%. Through this process, the researcher is usually able to have his article reviewed by colleagues before and after printing. They are the ones that ensure that the topic under which the researcher has written is credible and true. With more and more getting published in the journals, despite their high rejection rate that is, the world of science, healthcare, and technology are significantly improved and kept up to date on the progression the associated fields (Bornmann & Mungra, 2011). This process of peer reviewing too can be improved if the following were to be considered. Because of its nature of networking, it is a good process. However, the journals act as “gate keeps” by the hand of the editors who are the final say about the fate of a manuscript that is sent to their journal for publication. Unlike other networks where the channels are open to manipulation as one desires, here one has to pass through the editors before they can achieve the satisfaction of reaching members of the public and fellow colleagues in the same fields. If the editorial acceptation process was removed and researchers were allowed to present their work directly, this would help in the delivery of the information. Editors spend too much looking through the manuscript and having it reviewed by others. This time can be reduced tremendously and still the same process takes. By setting up direct submission of papers for peer reviewing, they could cut back on the time used before publication. The submission can be done to private databases, non-affiliated websites, and open groups where invites are sent out to other researchers to review the manuscript. Once at least three reviews are obtained and the paper rated accordingly, the paper is published on a website in the designated disciple with the reviewers’ comments and suggestion posted along with it. This process is shorter, saving time and money since the website can be free for public viewing and manuscript submission. This eliminates the “gate keeps” problem also. This style of peer reviewing would help curb the challenges faced by researchers who try and fail severally in attempting to get their paper published in journals. These are the researchers with that one special approach that has not been used yet it simplest to offer to the world of their designated field. In addition, research that yielded null results would be posted in this place give the fact that editorial teams do not give such manuscripts the time of day yet it saves people the time of wasting efforts and resources on studies that are fruitless. If all these were to be implemented and a paper liked and cited by fellow researchers in the designated field, then the writer would get the credit deserved just as one would if the same were published in a journal. The integration of technology into the peer review process would change it for the better. Organizations such as the American Academy of Nurse Practitioners use the peer review process in the setting of standards that would govern the practice of nurses and other healthcare workers helping them secure jobs at institutions and organizations such as CTCA. Through this process, they are able to let fellow researchers determine the best way forward for them as practitioners and once seen by organizations that need them, they are considered for the position. At times, though, they are not considered based on these reviewed papers. An example of such a situation is in the publication of standard of practice by American Academy of Nurse Practitioners. In this document, the scope of the profession is described by the ‘W’ ‘H’ questions and the same is applied for advanced nursing practice. With the collaboration with other organizations, they have developed good stands that help in the management treatment of disease that are affecting patients’ nation and even worldwide. Aimed at setting the bar, they clearly give operational regulations, which the nurses are to follow in the different field that they may find themselves in. These include (Nursingworld.org, 2014): 1. Anesthesia 2. Critical care 3. Midwifery 4. Oncology 5. Pediatrics 6. Mental Health In association with the Oncology Nursing Society, AANP publishes Oncology Practitioners Competencies, which outlines the specialty requirement level for entry for practitioners who care for adult and late adolescent patients throughout the length of their treatment and therapy for cancer and their roles during these processes (Nursingworld.org, 2014). By setting these they enable agencies and organizations know about the roles and activities that should performed by the nurses thus employing them accordingly. Those who do not meet the requirements are however not employed and are therefore forced to go and get the necessary credentials in order to receive a position in the organization. This keeps the nurses on their toes too since they do not want to lose their jobs or opportunities to get better jobs due to failing to meet a standard. In these published papers, apart from including the roles and requirements that are to be met, they include legal actions and other benefits that can be received or offered to the practicing nurse. This is especially in the advanced nursing side of the job. According to a paper published by the American Nurses Association in which they were discussing the new age of health care, practicing nurses is informed of the new opportunities to work with the removal of certain barriers. It states, that as millions more patients are expected to access health care services under the Affordable Care Act, better known as Obamacare, advanced practice registered nurses (APRNs) should be prominent in the provision of that care (American Nurses Association, 2011). This is because they have had their roles and responsibilities increased in to deliver safe and high quality health care. APRNs have finished basic education, masters and have acquired their doctorates in nursing practice under one of the following: Preventive care Primary Care Chronic Care It also informs the practitioners on opportunities. It urges APRNs to practice to their full educational and training levels, recommending their roles be reformed to conform to the implementation of the new health care act (American Nurses Association, 2011). They advocate for the impeachment of legislative and regulatory barriers that impede their practice so as to allow them to fully and independently practice based on their education and training. From the information offered from parts of the American Nurses Association publication, it is clear to see that the use of the peer reviewed process is beneficial to organizations that are co-dependent on the success of each other. CTCA is an organization that requires nurses would make sure it advocates for the above so that it may be able to get the best nurses available. Practicing nurses on the other hand would ensure that they acquire what is necessary following the advice offered by their regulatory board in order to achieve the best jobs that they are able to get. In general, it is quite evident that organizations like the Cancer Treatment Centers of America and the American Academy of Nurse Practitioners among others, even in different fields and professions require the aid of the peer reviewed process in order to improve, maintain with current working conditions and get their names recognized through the publication of advancements by researchers from their organization. The peer review processes may differ or be similar in execution, for example the review of articles for publication in journals is similar for the American Academy of Nurse Practitioners and Cancer Treatment Centers of America, but the peer reviewed process for evaluation of employees and their efficiency in carrying out their duties is different. CTCA performs an internal review through the interviewing of employees and questioning them on the roles played by coworkers and their efficiency in carrying out their responsibilities. AANP on the other hand, since it is a regulatory body and relies on the reports handed in by the employers of the nurses and will thus review those reports instead of interviewing the nurses in person. By improving some of the aspects of both types of reviews that CTCA uses it increases the efficiency of the process. Introducing an external reviewer in the process reduces the pressure mounted on employees of being reviewed by someone they have had a prior encounter with and eliminates the suspicion of which of the officials would do the reviewing. This eases the reviewer to a point of openness. Also reducing the number of times that the process is done in a year gives the organization the chance to get different results and a window to catch up with the new environment that it might have implemented after its previous review process. For reviewing of articles, removing the editor eliminates the issue of gate keeping that is evident in the current process. Because the editor is the last say on what is and what is not published in his paper, and the decision process is time consuming, removing him from the picture eases the publication process. The time taken is reduced significantly with at least three reviewers will do his job and the paper published on a web page that allows for further review posting all comments and responses. It also increases the speed at which the research is used or applied in real situations Lastly, the process is used in the credentialization of organizations and ensures the quality and improvement of advances in practice. This is clear from the way regulations are written by AANP in the roles and responsibilities that are meant to be carried out by nurses as they practice and also the requirements need to qualify for that specific job be it in primary, preventive, or chronic care. By doing this, it informs organizations such as CTCA on the best people to hire for their hospitals and clinics as well as the required qualifications in a well clued-up manner. It also provides practitioners a chance to improve their working conditions as shown by the American Nurses Association. They provided information on the new opportunities made available by the implementation of the new health care act and ways of maximizing opportunities through the advancement of one’s career. It also advocated for the laxity in regulations that would otherwise prevent practicing nurses reaching their potential in their field of work. References American Nurses Association. (2011). Advanced Practice Nursing: A New Age In Health Care. Bornmann, L. & Mungra, P. (2011). Improving peer review in scholarly journals. European Science Editing, 37(2), 41--43. Kent, K. (2014). Advance for Nurses | Printer Friendly.Nursing.advanceweb.com. Retrieved 25 April 2014, from http://nursing.advanceweb.gov/Editorial/Content/PrintFriendly.aspx?CC=48967 Nursingworld.org. (2014). Scope and Standards of Practice. Retrieved 25 April 2014, from http://www.nursingworld.org/scopeandstandardsofpractice Sheahan, S., Simpson, C., & Rayens, M. (2001). Nurse Practitioner Peer Review: Process and Evaluation. Journal Of The American Academy Of Nurse Practitioners, 13(3), 140-144. Read More