Feasibility of peer assessment and clinical audit to self-regulate the quality of physiotherapy services: a mixed methods study

Abstract

ObjectivesTo evaluate the feasibility of a quality improvement programme aimed to enhance the client-centeredness, effectiveness and transparency of physiotherapy services by addressing three feasibility domains: (1) acceptability of the programme design, (2) appropriateness of the implementation strategy and (3) impact on quality improvement.DesignMixed methods study.Participants and setting64 physiotherapists working in primary care, organised in a network of communities of practice in the Netherlands.MethodsThe programme contained: (1) two cycles of online self-assessment and peer assessment (PA) of clinical performance using client records and video-recordings of client communication followed by face-to-face group discussions, and (2) clinical audit assessing organisational performance. Assessment was based on predefined performance indicators which could be scored on a 5-point Likert scale. Discussions addressed performance standards and scoring differences. All feasibility domains were evaluated qualitatively with two focus groups and 10 in-depth interviews. In addition, we evaluated the impact on quality improvement quantitatively by comparing self-assessment and PA scores in cycles 1 and 2.ResultsWe identified critical success features relevant to programme development and implementation, such as clarifying expectations at baseline, training in PA skills, prolonged engagement with video-assessment and competent group coaches. Self-reported impact on quality improvement included awareness of clinical and organisational performance, improved evidence-based practice and client-centeredness and increased motivation to self-direct quality improvement. Differences between self-scores and peer scores on performance indicators were not significant. Between cycles 1 and 2, scores for record keeping showed significant improvement, however not for client communication.ConclusionsThis study demonstrated that bottom-up initiatives to improve healthcare quality can be effective. The results justify ongoing evaluation to inform nationwide implementation when the critical success features are addressed. Further research is necessary to explore the sustainability of the results and the impact on client outcomes in a full-scale study.

Impact of Self- and Peer Assessment on the Clinical Performance of Physiotherapists in Primary Care: A Cohort Study

“…Self-assessment scores were lower than peer-assessment scores in both cycle 1 and cycle 2, indicating that participants either underestimated themselves or overestimated their peers. These outcomes are supported by our feasibility study 31 and are in line with the literature on self-assessment and peer assessment. 19,47,48 In cycle 2, the differences between the self-assessment and peer-assessment scores diminished because of the higher self-assessment scores-in particular, the scores for client communication.…”

“…A standard of 5% performance improvement was estimated on the basis of the results Ivers and colleagues' 25 meta-review on the effects of auditing and feedback on professional practice. In the sample of 67 participants in our previous feasibility study, 31 we observed self-assessed and peer-assessed performance improvement of 6% (p ¼ 0.007) and 4% (p ¼ 0.002), respectively, for recordkeeping. Because the feasibility study included a single network, we aimed to verify those results in this study by including at least four networks and 200 physiotherapists.…”

“…30 We reported the results for the first two steps, programme development and feasibility testing, in a previous study. 31 The feasibility study showed significant improvement in performance. However, the sample size was small (n ¼ 64), and all participants were part of a single professional network, which limited the internal and external validity of the results.…”

Purpose‐built national burns center: The Israeli experience

“…Finally, we are currently collecting data on the quality of treatment compared to other burn units in Israel. Clinical audits are a valuable and common strategy to improve the quality of health care and its delivery (Maas et al, ). The SMC conducts quarterly audits and monitors major areas, including medications, infectious disease control, pain management, and diabetes, and the NBC performs monthly audits of practices within the department.…”

Gestão assistencial da fisioterapia hospitalar: indicadores

“…A iniciativa de desenvolver indicadores táticos, estratégicos e painéis de controle gerencial atenderá às práticas recomendadas a todos os serviços de saúde, incluindo os de fisioterapia, proporcionando adequado direcionamento aos gestores e gerando evidências de qualidade assistencial [31][32][33]. Espera-se que em um futuro breve, novos estudos impulsionem os processos de qualidade da fisioterapia no ambiente hospitalar.…”