Peer review may be an effective strategy for assessing clinical performance and uncovering potential safety issues, but concerns have been raised that these programs may hinder safety culture due to a perceived focus on punitive actions. This study explored peer review data collected from 135 Veterans Affairs (VA) facilities. More than 23,000 cases were peer reviewed between October 2011 and September 2012. Approximately 10% of all referred cases were designated as substandard care, representing approximately 17 cases per facility. Diagnosis-related concerns were estimated to occur in 0.5% of all hospital admissions. The authors note that a benefit of peer review is that it focuses on individual decision-making, which few other current safety measures accurately capture. A prior AHRQ WebM&M perspective by Dr. Ashish Jha discussed the many efforts by the VA to improve quality and safety, including the development of the peer review program.