Pyramid for Promoting Reliability and Professional Accountability

The pyramid illustrates a tiered intervention approach that supports pursuit of professional accountability. CPPA designed PARS and CORS to promote successful self- and group-regulation.

  • The Pyramid reminds us that most clinicians do great work and are never or only rarely associated with a complaint.
  • Recorded reports are reviewed to ensure allegations do not require mandated reviews or investigations (e.g., impairment, bias, inappropriate touch, fraud, harassment,), but can simply be shared in a respectful, non-directive fashion during an informal conversation such as one might have with a colleague over a cup of coffee.
  • When patterns appear to emerge, CPPA supports peer-delivered Level 1 Awareness interventions with local and national peer comparisons as described above. Most clinicians respond to awareness interventions.
  • Some, however, are unable or unwilling, and these clinicians are escalated to Guided Interventions by Authority (Level 2). Level 2 interventions include a written corrective plan developed by the individual’s authority figure (a department chair, Chief Medical Officer, or other leader).
  • A very small number may not respond to the plan and are elevated to Level 3 disciplinary action as defined by organizational policies, bylaws, contracts or other governing documents.

Participation in the CPPA PARS and CORS process includes extensive education regarding the use of the tiered interventions shown in the Professional Pyramid.


Center for Patient and Professional Advocacy
Vanderbilt University Medical Center

2135 Blakemore Avenue | Nashville, TN 37212-3505 | Phone: 615-343-4500 (CPPA office) | Fax: 615-343-8580

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