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A. Peer Support Program Structure

The first step in creating your Peer Support program is to establish the program structure, including the program model, budget and funding sources, location(s) within the institution, peer review privileges, and documentation.

Program Model
Hospital and unit/department leadership can decide between a local, centralized, or hybrid Peer Support program
model. Which model you select will depend on your institution’s size, goals, and resources.

  1. Centralized
    The Peer Support program is housed exclusively in a centralized location, such as the Department of Quality. Clinicians and unit/department leadership can request Peer Support services and resources through the centralized program. Peer Supporters are deployed, managed, and tracked by central leadership.
  2. Local
    Local unit/department leadership establish their own local Peer Support programs. For example, the Nursing Director of the Surgical Intensive Care Unit, or the Chief of Pharmacy, can create their own local Peer Support programs. Peer Supporters are deployed, managed, and tracked by local leadership.
  3. Hybrid (Recommended)
    Both centralized and local programs exist. Local leadership manage their local Peer Support programs as above, while the centralized program ensures the hospital-wide success of the program, and deploys Peer Supporter for staff who belong to units/departments where there are no local Peer Support programs, thereby ensuring accessibility to Peer Support for the entire institution. Local leadership can utilize the centralized program resources until their local programs are fully developed.

Program Budget and Funding
Leadership should also determine the budget and funding sources for the program. Some costs to take into consideration when developing a program budget include:

  • Staff Payroll.
  • Contract fees (e.g. outside contracts with marketing, graphic design, IT, videographer, or legal professionals).
  • Survey and data collection software (e.g. RedCap, SurveyMonkey, Microsoft Suite).
  • HIPAA compliant Zoom account(s) for use during Peer Support Discussions.
  • Website domain and hosting.
  • Registration platform for scheduling Peer Supporter trainings.

Program Location(s) Whithin the Institution
Leadership should determine where the central and/or local Peer Support program(s) will be housed/piloted. For example, the central Peer Support program can be housed in the Department of Quality and Safety, and local Peer Support programs can be piloted in willing nursing units and/or clinical departments.

Peer Review Protection
Peer Support is designed to provide Peer Review Protection, which prevents patient-plaintiffs from obtaining any records prepared in connection with adverse event management and quality review proceedings. This empowers Peers to discuss the details of adverse events or difficult situations without fear of professional or legal repercussions.

Below are steps to build Peer Review Protection into your Peer Support program:

  • Triage and track Peer Support deployments within your secure safety reporting system or other HIPAA-compliant/encrypted software.
  • Program responsibilities should fall under a department or group that has peer review protection privileges, and such roles, responsibilities, and privileges should be documented in your QAPI (Quality Assurance and Performance Improvement) Plan or other institutional document.
  • Train Peer Supporters on the importance of confidentiality and protected conversations.
  • Disclaimer: Peer Review Protection can never be guaranteed and is dependent on local judicial discretion. Check with your local jurisdiction to learn relevant Peer Review Protection and professional liability laws.

Program Documentation
In order to formally establish the Peer Support program and to align program goals with institutional goals, The Peer Support program structure, scope, and goals should be summarized/included in a Quality Assurance and Performance Improvement (QAPI) plan, business plan, charter, or other institutional document.

Peer Support Program Structure: To Do’s
☐ Select Peer Support program model that best matches your institution’s goals and resources
(centralized, local, or hybrid)

☐ Determine program budget and funding sources

☐ Determine where central and/or local Peer Support program(s) will be housed/piloted

☐ Learn local Peer Review Protection and professional liability laws, and determine steps to provide Peer Review Protection within the Peer Support program

☐ Add Peer Support program to QAPI plan, business plan, charter, or other institutional document

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