Clinical Performance Feedback to Paramedics: What They Receive and What They Need

Abstract

Objectives: Performance feedback is not always well utilized in healthcare. To more effectively incorporate it, we used a discussion of current feedback systems to explore paramedics' perceived needs regarding feedback and to understand what feedback would improve their performance as healthcare providers. Methods:We used a qualitative methodology with semistructured interviews of paramedics to explore perceptions and desires for feedback. Interpretive descriptive analysis was performed with continuous recruitment until thematic saturation was achieved. Themes were identified and a coding system was developed by two investigators separately and merged by consensus. The analysis was audited by a third investigator, and a member check was performed.Results: Many different ideas were discussed that were analyzed to develop several major recurrent themes.One such theme was positive perception of feedback by paramedics. Despite the positive perceptions discussed, the shortcomings of current systems were also frequently discussed as were perceived barriers to receiving meaningful feedback. The idea of following up on patients' courses/outcomes also arose frequently during the interviews. In addition, feedback and its interaction with mental health emerged as a theme in terms of its potential for both positive and negative impact. Finally, suggestions about the future were also common with paramedics providing thoughts regarding what future systems could be developed or what changes could be made to provide them with meaningful feedback. Conclusions:Our findings show how paramedics perceive feedback, but still note how barriers may impair its uptake and how it may affect their mental health. Our participants also made recommendations about what they would want to see in future feedback systems. This information can provide the foundation to improve current feedback systems or structure new ones to allow paramedics to continue to develop themselves as healthcare professionals.P erformance feedback on medical care and outcomes in prehospital care is generally infrequent and inconsistently delivered. 1 Research has also produced unreliable results regarding the value of feedback to health professionals-potentially reflecting the variation in content of feedback, the context of the feedback, and the mode of delivery. [2][3][4][5] This suggests that not all feedback is equal: not all feedback systems achieve their intended end of prompting performance improvement. 6,7 Some may point out systems-level changes (e.g., process improvement), 3 while others may not provide enough meaningful information to

Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians

“…Therefore, it is problematic, and indeed paradoxical, that there is an absence of performance feedback following these assessments. Clinical performance feedback is imperative for facilitating performance improvement and maintaining competence 38 41. Furthermore, subsequent clinical performance feedback can cause a shift in patient safety culture on a systematic level, instigating a more accepting atmosphere in which individuals dare to discuss and reflect on errors committed in clinical practice 41.…”

“…Clinical performance feedback is imperative for facilitating performance improvement and maintaining competence 38 41. Furthermore, subsequent clinical performance feedback can cause a shift in patient safety culture on a systematic level, instigating a more accepting atmosphere in which individuals dare to discuss and reflect on errors committed in clinical practice 41. Therefore, continuously performing complex non-conveyance assessments without performance feedback is a barrier for ACs’ professional development.…”

Paramedic experiences of using an enhanced stroke assessment during a cluster randomised trial: a qualitative thematic analysis

“…Paramedics regarded it as a beneficial learning experience professionally because it allowed them to receive feedback and see how the information they provided during handover was used to inform care decisions made by the hospital team ( box 5 : Quotation 7). 15 For some, these experiences underpinned reflection on their practice and enriched their professional knowledge. However, the overall view was that time constraints would make it difficult to routinely implement extra time in hospital as a way of contributing towards patient care or professional development.…”

“…Previous interviews with Canadian paramedics also found positive perceptions of feedback, but this was described as informal and opportunistic. 15 Audit of clinical documentation and feedback to individual paramedics has been shown to encourage adherence to standard stroke care assessment but was not in real time and did not allow clarification by the recipient. 7 Future studies should consider the value of immediate and structured paramedic feedback for those scenarios where specific actions are required during the prehospital assessment.…”

Prompting Paramedics: The Effect of Simulation on Paramedics’ Identification of Learning Objectives

“…Interventions using interaction-based educational methods have shown to be more effective in improving learning than those using didactic methods [2-3]. Other interventions, such as clinical practice feedback, has been met previously with resistance - since feedback about real cases can be perceived as unsafe and possibly threatening [4]. Understanding what continuing medical education (CME) tools are most effective in fostering knowledge retention and application is therefore critical in improving clinical outcomes.…”