How does audit and feedback influence intentions of health professionals to improve practice? A laboratory experiment and field study in cardiac rehabilitation

Gude, Wouter T.; Engen-Verheul, Mariëtte M. van; Veer, Sabine N van der; Keizer, Nicolette F. de; Peek, Niels

doi:10.1136/bmjqs-2015-004795

Cited by 42 publications

(53 citation statements)

References 33 publications

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“…This chain is only as strong as its weakest link. Feedback effects can be weakened by information-intention gaps (feedback fails to convince recipients that change is necessary), intention-behaviour gaps (intentions are not translated into action), or behaviour-impact gaps (actions do not yield the desired effect on patient care) 9. The success of national audit programmes depends on local arrangements that promote action as well as measurement 10…”

Section: Pay Attention To the Whole Cyclementioning

confidence: 99%

Revitalising audit and feedback to improve patient care

Foy

Skrypak

Alderson

et al. 2020

BMJ

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Section: Pay Attention To the Whole Cyclementioning

confidence: 99%

Revitalising audit and feedback to improve patient care

Foy

Skrypak

Alderson

et al. 2020

BMJ

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“…Therefore, those informed by A&F may be better able to focus their time and resources available for quality improvement more efficiently on those care aspects that need it most. However, previous studies have shown that feedback messages are rejected when recipients do not trust the data, disagree with benchmarks, consider improvement unfeasible, or do not consider the clinical topic an important aspect of care quality [ 6 – 9 ]. An empirical study showed that health professionals ignored between a third and half of the improvement recommendations when confronted with feedback on multiple quality indicators [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Health professionals’ perceptions about their clinical performance and the influence of audit and feedback on their intentions to improve practice: a theory-based study in Dutch intensive care units

et al. 2018

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BackgroundAudit and feedback aims to guide health professionals in improving aspects of their practice that need it most. Evidence suggests that feedback fails to increase accuracy of professional perceptions about clinical performance, which likely reduces audit and feedback effectiveness. This study investigates health professionals’ perceptions about their clinical performance and the influence of feedback on their intentions to change practice.MethodsWe conducted an online laboratory experiment guided by Control Theory with 72 intensive care professionals from 21 units. For each of four new pain management indicators, we collected professionals’ perceptions about their clinical performance; peer performance; targets; and improvement intentions before and after receiving first-time feedback. An electronic audit and feedback dashboard provided ICU’s own performance, median and top 10% peer performance, and improvement recommendations. The experiment took place approximately 1 month before units enrolled into a cluster-randomised trial assessing the impact of adding a toolbox with suggested actions and materials to improve intensive care pain management. During the experiment, the toolbox was inaccessible; all participants accessed the same version of the dashboard.ResultsWe analysed 288 observations. In 53.8%, intensive care professionals overestimated their clinical performance; but in only 13.5%, they underestimated it. On average, performance was overestimated by 22.9% (on a 0–100% scale). Professionals similarly overestimated peer performance, and set targets 20.3% higher than the top performance benchmarks. In 68.4% of cases, intentions to improve practice were consistent with actual gaps in performance, even before professionals had received feedback; which increased to 79.9% after receiving feedback (odds ratio, 2.41; 95% CI, 1.53 to 3.78). However, in 56.3% of cases, professionals still wanted to improve care aspects at which they were already top performers. Alternatively, in 8.3% of cases, they lacked improvement intentions because they did not consider indicators important; did not trust the data; or deemed benchmarks unrealistic.ConclusionsAudit and feedback helps health professionals to work on aspects for which improvement is recommended. Given the abundance of professionals’ prior good improvement intentions, the limited effects typically found by audit and feedback studies are likely predominantly caused by barriers to translation of intentions into actual change in clinical practice.Trial registrationClinicalTrials.gov NCT02922101. Registered 26 September 2016.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0727-8) contains supplementary material, which is available to authorized users.

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“…We believe that the high compliance and the key factors of the persistence of multimodal intervention to control MDROs in LMICs were associated closely to the following issues: (1) practicable A&F interventions on improving quality needs an organizational structure and strong leadership in the institute [19,22]; (2) it is more practicable to transform main components into standardized implementation indicators that can be observed objectively in auditing 35 ; (3) quantitative analysis can help to count or measure what is happening now and guide clinical practices [26]; (4) specifying the working scope of doctors and nurses to construct separate implementation indicators, feedback and education can greatly enhance the intervention implementation; (5) benchmark comparison clearly from feedback report could inspire clinical staff to improve the implementation on those indicators below benchmark e ciently according to the control theory [22,24].…”

Section: Discussionmentioning

confidence: 99%

“…In the monthly feedback group, monthly written feedbacks were delivered to clinical staff and the IPC committees of departments. The written feedback included the mean level of a hospital as the benchmark and department individual level of 40 A&F implementation indicators [24]. In quarterly feedback group, written feedbacks were delivered quarterly, with the other measures the same as the monthly feedback group.…”

Section: Study Settingmentioning

confidence: 99%

Using Audit and Feedback and the Benchmark to Enhance Infection Prevention and Control of Multidrug Resistant Organisms: a Quasi-experiment Study

Zhou

Lai

Zhang

2020

Preprint

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BackgroundInfection prevention and control (IPC) is important to prevent the spread of multidrug resistant organisms (MDROs). We aimed to enhance and explore the implementation of preventing and controlling MDROs using audit and feedback and the benchmark. MethodsThis quasi-experimental design was conducted in three hospitals from 1st March 2018 to 30th September 2019. A multimodal intervention treated audit and feedback and benchmark as key components for MDROs IPC was conducted in Wuhan, China. A checklist of 40 implementation indicators based on IPC measures was formed to guide the audit twice a week. Immediate feedback was verbally given after each audit on the spot, and written feedbacks containing benchmark and individual implementation levels were delivered monthly or quarterly in three hospitals. The intervention effect was evaluated by Chi-square and Poisson segmented linear regression. Impacts of implementation of indicators on the incidence were modeled by mixed-effect regressions. ResultsThe incidence of nosocomial MDROs decreased by 19.39%, 20.55%, and 24.03% in A, B, and C hospital, respectively. The lowest implementation compliance of indicators was the use of personal protective equipment of doctors (50.24%). The highest was isolated warning signs of nurses (96.46%). The implementation on hand hygiene of doctors (Coef. = -27.87, p=0.001) and nurses (Coef. = -35.44, p=0.001), clean of surrounding instruments and bed unit (Coef. = -4.84, p=0.030), education to patients and relatives (Coef. = -59.51, p=0.031), and sending of specimen inspection timely (Coef. = -9.95, p<0.001) were negatively associated with the incidence of nosocomial MDROs infection. Conclusions The multimodal intervention by strengthening the implementation of audit and feedback and the benchmark is feasible and effective in China. The checklist is an effective and practical tool to measure the level of implementation. Education to patients and relatives, hand hygiene, clean of surrounding instruments and bed unit, and sending of specimen inspection timely are especially crucial.

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How does audit and feedback influence intentions of health professionals to improve practice? A laboratory experiment and field study in cardiac rehabilitation

Abstract: NTR3251, pre-results.

Cited by 42 publications

References 33 publications

Revitalising audit and feedback to improve patient care

Revitalising audit and feedback to improve patient care

Health professionals’ perceptions about their clinical performance and the influence of audit and feedback on their intentions to improve practice: a theory-based study in Dutch intensive care units

Using Audit and Feedback and the Benchmark to Enhance Infection Prevention and Control of Multidrug Resistant Organisms: a Quasi-experiment Study

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