The impact of patient feedback on the medical performance of qualified doctors: a systematic review

Abstract

BackgroundPatient feedback is considered integral to quality improvement and professional development. However, while popular across the educational continuum, evidence to support its efficacy in facilitating positive behaviour change in a postgraduate setting remains unclear. This review therefore aims to explore the evidence that supports, or refutes, the impact of patient feedback on the medical performance of qualified doctors.MethodsElectronic databases PubMed, EMBASE, Medline and PsycINFO were systematically searched for studies assessing the impact of patient feedback on medical performance published in the English language between 2006-2016. Impact was defined as a measured change in behaviour using Barr’s (2000) adaptation of Kirkpatrick’s four level evaluation model. Papers were quality appraised, thematically analysed and synthesised using a narrative approach.ResultsFrom 1,269 initial studies, 20 articles were included (qualitative (n=8); observational (n=6); systematic review (n=3); mixed methodology (n=1); randomised control trial (n=1); and longitudinal (n=1) design). One article identified change at an organisational level (Kirkpatrick level 4); six reported a measured change in behaviour (Kirkpatrick level 3b); 12 identified self-reported change or intention to change (Kirkpatrick level 3a), and one identified knowledge or skill acquisition (Kirkpatrick level 2). No study identified a change at the highest level, an improvement in the health and wellbeing of patients. The main factors found to influence the impact of patient feedback were: specificity; perceived credibility; congruence with physician self-perceptions and performance expectations; presence of facilitation and reflection; and inclusion of narrative comments. The quality of feedback facilitation and local professional cultures also appeared integral to positive behaviour change.ConclusionPatient feedback can have an impact on medical performance. However, actionable change is influenced by several contextual factors and cannot simply be guaranteed. Patient feedback is likely to be more influential if it is specific, collected through credible methods and contains narrative information. Data obtained should be fed back in a way that facilitates reflective discussion and encourages the formulation of actionable behaviour change. A supportive cultural understanding of patient feedback and its intended purpose is also essential for its effective use.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1277-0) contains supplementary material, which is available to authorized users.

Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review

“…As there is currently no consensus on the use of critical appraisal in the synthesis of qualitative research, we did not set a priority quality threshold nor did we exclude papers/reports on the basis of quality. Similarly to other systematic reviews, conceptual relevance took precedence over methodological rigour. Appraisal was conducted to improve transparency in the systematic review process.…”

Feedback Redefined: Principles and Practice

“…Integration of patient feedback into performance assessment is fraught with challenges, but if implemented effectively, it could trigger meaningful behavior change and enhance safety and quality in patient care. 65 More research is needed in this important area.…”

Reflection in practice: How can patient experience feedback trigger staff reflection in hospital acute care settings?

“…The idea that reflection will lead to learning and improvement is based on the work of Dewey from the 1930s and continued with models such as Schön and Gibbs designed to support reflective practice . Whether reflection prompts learning and change has been questioned, although some studies have identified changes in behaviour as a direct result of reflection taking place within clinical practice settings . Reflective practice is now mandated for most health professionals, with documented evidence of reflecting on patient and colleague feedback required for continuing professional development and revalidation.…”

“…[13][14][15][16] Whether reflection prompts learning and change has been questioned, although some studies have identified changes in behaviour as a direct result of reflection taking place within clinical practice settings. [17][18][19][20] Reflective practice is now mandated for most health professionals, with documented evidence of reflecting on patient and colleague feedback required for continuing professional development and revalidation. Despite the focus on retrospective written reflection, increasingly, arguments are being made that reflection, and in particular reflection in action, should instead be fully embedded within the multiple contexts of clinical practice.…”