Focused Professional Practice Evaluation and the Weaponization of Anonymous Reporting: Erosion of Care and Fairness

Importance Focused professional practice evaluation (FPPE) was designed to increase patient safety, and anonymous reporting systems are often implemented to empower staff at all levels of an organization to speak up without the fear of reproach. However, the impact of these systems on patient outcomes remains largely unexamined. In this study, we survey physicians to assess whether they believe these mechanisms improve patient care or well-being. Objective The goal of this study was to assess potential declines in patient safety and care due to FPPE and anonymous reporting, as well as their potential misuse, through physician participation in a 29-question survey. Design, setting, participants A 29-question survey was conducted from February to March 2025, targeting a national sample of 152 U.S.-based surgeons. The survey included 29 questions addressing experiences with FPPE/anonymous reporting, perceptions of fairness, career consequences, and clinical practice changes. Main outcomes The primary outcomes that this study hoped to measure were changes in patient care and the impacts on the lives of surgeons. Results Of 152 physician respondents, 19.1% stated they had never been on the receiving end of a filed report. Despite this distinction, they described negative trends in patient care as well as professional practice similar to those experienced by individuals who had been reported. Respondents identified ways in which anonymous reporting and FPPE processes potentially compromise patient care: 57% (n=68) avoided high-risk cases, 70.8% (n=85) practiced defensively, 45.5% (n=56) reported erosion of operating room camaraderie and trust, and some described overprescription of narcotics or sedatives to placate staff. Many physicians feared retaliation for raising safety concerns or confronting problematic behavior, particularly from nursing staff, leading to widespread silence. In addition, many expressed personal accounts of deteriorating work culture, ruined careers, emotional distress, and even suicidal ideation. These systems not only led to real and direct harm to patients but also held the potential to be weaponized by those in power, and many respondents who felt as such cited a lack of due process, inconsistent standards, and vague or unverifiable allegations. Supporting this, 64.2% (n=79) deemed FPPE unfair, 62.3% (n=76) cited differential treatment, and 50.8% (n=62) encountered opaque or unclear disputes. Overall, only 6% (n=6) rated FPPE as an effective and positive influence on patient outcomes, with an average rating of 2.23/5. Conclusions and relevance Originally intended as a quality improvement measure, FPPE and anonymous 360 reporting systems create a net decline in patient care and safety, leading to real patient harm. In addition, it is often uninfluenced by metrics such as morbidity and mortality, and many claims can be made without validity, leading to serious detriments to physician mental health, retention, and professional careers. Due to the extensive implementation of these processes across many institutions, further investigation is required to appropriately guide reform, and as such, we encourage all physicians to share their personal opinions on these systems and participate in this survey [19].