The impact of audit and feedback to support change behaviour in healthcare organisations - a cross-sectional qualitative study of primary care centre managers

Abstract

Background This article addresses the role of audit and feedback (A&F) to support change behaviour and quality improvement work in healthcare organisations. It contributes to the sparse literature on primary care centre (PCC) managers´ views on A&F practices, taking into account the broad scope of primary care. The purpose was to explore if and how different types of A&F support change behaviour by influencing different forms of motivation and learning, and what contextual facilitators and barriers enable or obstruct change behaviour in primary care. Methods A qualitative research approach was used. We explored views about the impact of A&F across managers of 27 PCCs, in five Swedish regions, through semi-structured interviews. A purposeful sampling was used to identify both regions and PCC managers, in order to explore multiple perspectives. We used the COM-B framework, which describes how Capability, Opportunity and Motivation interact and generate change behaviour and how different factors might act as facilitators or barriers, when collecting and analysing data. Results Existing forms of A&F were perceived as coercive top-down interventions to secure adherence to contractual obligations, financial targets and clinical guidelines. Support to bottom-up approaches and more complex change at team and organisational levels was perceived as limited. We identified five contextual factors that matter for the impact of A&F on change behaviour and quality improvement work: performance of organisations, continuity in staff, size of organisations, flexibility in leadership and management, and flexibility offered by the external environment. Conclusions External A&F, perceived as coercive by recipients of feedback, can have an impact on change behaviour through ‘know-what’ and ‘know-why’ types of knowledge and ‘have-to’ commitment but provide limited support to complex change. ‘Want-to’ commitment and bottom-up driven processes are important for more complex change. Similar to previous research, identified facilitators and barriers of change consisted of factors that are difficult to influence by A&F activities. Future research is needed on how to ensure co-development of A&F models that are perceived as legitimate by health care professionals and useful to support more complex change.

Effekte der gesetzlichen Qualitätssicherung in der akutstationären Versorgung

“…Allgemein haben die theoretische Untermauerung der Qualitätsrückmeldung und darauf aufbauend die Berücksichtigung derjenigen Faktoren, die die Wirkung von Rückmeldungen zu medizinischen Leistungsdaten beeinflussen, in Deutschland bisher wenig Beachtung gefunden. Zu nennen sind vor allem die Fähigkeit der Adressaten, die Daten zu interpretieren und in Verbesserungen umzusetzen, deren Meinung zur Glaubwürdigkeit der Daten, deren Motivation, die Art der Rückkopplung und Kontextfaktoren wie die Qualitätskultur des jeweiligen Krankenhauses [ 35 , 36 ].…”

Promises and pitfalls of value-based reimbursement in healthcare : A mixed method health economic approach

“…Research has shown that audit and feedback generally leads to small but potentially important improvements within healthcare (Ivers et al, 2012). Further, research has shown that external audit and feedback can increase the "knowwhat" and "know-why" types of knowledge which may impact behavioural changes among healthcare providers (Glenngård & Anell, 2021). This is the kind of knowledge that is related to the culture-cognitive pillar.…”

The management of healthcare employees’ job satisfaction: optimization analyses from a series of large-scale surveys

“…Our study is dedicated to identifying the mix of factors that are associated with an improvement of health professionals’ job satisfaction related to unit, organization, and regional government in the context of a series of large-scale surveys. Investigating employees’ satisfaction and perception about organizational climate with different governance levels seems essential in light of extant evidence showing the interconnection as well as the uniqueness of each governance layer in enhancing or threatening motivation and satisfaction across public administration fields, including government [ 12 , 13 ] and healthcare [ 14 – 16 ].…”