[Peer review procedures in pathology - more than ten years of experience in the free state of Saxony]

The positive experiences regarding peer review practice go back to the 1990s and can be traced in the position paper of the German Medical Association concerning quality assurance in the field of pathology. This evolved into the initiative of pathologists in Saxony to implement the peer review practice within the remit of their State Medical Association. Since the 14(th) of May 1999 various institutes as well as medical group practices in pathology and cytology have joined forces to undertake voluntary inter-institutional quality control measures. The aim was to improve the process and especially the outcome quality by reviewing each other's quality (analysing samples) on the basis of defined criteria. A positive review outcome report, which will have to be unanimously agreed upon by all participants, will lead to a positive recommendation for a certificate issued by the Medical Association of Saxony. Between 1999 and 2011 a total of 56 peer review proceedings took place. The potentials for improvement concern the problem of "kitchen pathology" still being used in the context of macroscopic description, the quality of microscopic description including the use of correct nomenclature, the quality of tumour classification and immune histological investigations. Statements concerning the advantage of the peer review method in particular refer to the integration of resident pathologists. Due to the long period of implementation of the peer review system und the small number of proceedings, it is not possible to come to a clear conclusion about the improvement or deterioration of quality. During a period of more than 10 years three peer review proceedings were not successful. In this situation, it is appropriate to ask the question of how restrictive peer reviews should be. The three most important aspects for the pathologists in Saxony are: self-determination, learning from each other, and a commitment to quality improvement. So this method set an example of how a quality management method can persist for more than 10 years through voluntary engagement. And the initiative of pathologists in Saxony has given an important impetus to the development of other peer review systems in various health care organisations or disciplines in Germany.