Prepare, listen, reflect - my experience as a peer reviewer for the diabetes quality programme

Dr Ambika Karthikeyan, Consultant Paediatrician at University Hospital Coventry & Warwickshire, participated in her first peer review for the College's national diabetes quality programme in late 2021. She tells us what she learned from the process and what she would do differently next time. And, we give a quick explainer on how our peer review process works.
Dr Ambika Karthikeyan

My inspiration to become a peer reviewer for the RCPCH National Diabetes Quality Programme came from my own experience of being peer reviewed. The preparation, experience of being reviewed, the receiving of feedback and the impact on my service, led me to believe that I could make a contribution here.

And so, when the next opportunity for peer reviewer training came up, I went for it.

There was a bit of a gap from training to actually doing my first peer review, which meant confidence levels were down a couple of notches before the day. I knew that preparation was key. I also strongly felt that preparation showed respect for the efforts made by the service to collate and submit data.

However, in my effort to be prepared, I made the mistake of going through the documents too far in advance, which then meant having to set time aside to revisit the evidence again closer to the day. The peer review manager’s checklist of evidence of measures met was very helpful and guided me towards what aspects of the evidence needed closer scrutiny.

...the skills required were what you practice every day anyway - communication, empathy, diplomacy, listening and reflecting

I met my fellow peer reviewers and the peer review manager at the pre-review meeting and immediately felt at ease. The discussions reassured me that we were all working towards a common shared objective, strongly based on the ethos that we were reviewing a service very much as supportive peers.

The peer review day itself was a long day, particularly as on a virtual peer review you are sat in front of a screen all day. But in the end, it all ran smoothly. The preparation time between sessions allowed us to discuss key issues to explore and agree on who would lead what aspects of the review.

It was a bit daunting to think you had to speak with senior managers and parents of children who were not your patients. But, at the end of the day, the skills required were what you practice every day anyway - communication, empathy, diplomacy, listening and reflecting. I certainly needed all those skills to come together when delivering feedback at the end of the day. It is never pleasant to have to deliver feedback on ‘areas of concern’ but the support from the RCPCH team at the debrief afterwards proved invaluable.

 The ideas for good practice and innovative working... the realisation that every service has its own challenges and the inspiration from talking to passionate colleagues were just some of the many positives.

Being a first-time peer reviewer was quite an experience. The ideas for good practice and innovative working that you pick up from reviewing another service, the realisation that every service has its own challenges and the inspiration from talking to passionate colleagues were just some of the many positives I took away from my first peer review.

My top tips for first time reviewers? Prepare, but not too early; type up your notes as you go and upload them on the same day (be careful not to accidentally hijack someone else’s notes like I did!); and just bring with you the same enthusiasm that you bring to your everyday practice.

About the programme

The RCPCH National Diabetes Quality Programme works with paediatric diabetes units (PDUs) in England and Wales to improve multidisciplinary care for children and young people with diabetes in the NHS, reducing unwarranted variations and involving families in service improvement in a developmental way. 

As part of the Quality Assurance (QA) stream, all participating PDUs receive a peer review. A multidisciplinary team of peers speak with the service team, relevant colleagues, patients and families to determine compliance against the standards and to identify areas of good practice for sharing more widely and recommendations to improve outcomes.

The peer review process

The peer review workstream builds on the Department of Health’s Diabetes Quality Improvement Network System.

It's the process by which professionals, including a paediatric consultant, paediatric diabetes specialist nurse, dietitian, and psychologist, and supported by members of the RCPCH Diabetes Quality Programme staff team, examine the PDU's processes, team working, governance, outcomes and engagement with patients and families.

The approach is developmental, encouraging teams to share their achievements so that good practice can be disseminated, as well as highlighting challenges so that barriers can be explored.

Find out more about NDQP peer reviews

The peer review team

The peer review provides an opportunity for a team of peers to meet with members of the PDU, facilitating discussion and questioning with the aim of determining compliance against a series of NDQP measures, and identifying a broader set of themes concerned with the delivery of a high quality and safe service, including patient experience.

The interaction at the review and the resulting report and recommendations will provide PDU teams with the tools and evidence to plan their improvement, supplemented by the opportunity of the Quality Improvement Collaboratives within the overall programme.

The peer review team typically includes at least two clinical colleagues (doctor, nurse, dietitian, psychologist). The team is supported by a Review Manager – this may be a RCPCH staff member or an external consultant acting on behalf of the RCPCH – and additional staff members to facilitate virtual delivery.

Find out more about NDQP peer reviews

Find out more about NDQP peer reviews