Model depicting aspects of audit and feedback that impact physicians’ acceptance of clinical performance feedback

Abstract

BackgroundAudit and feedback (A&F) is a strategy that has been used in various disciplines for performance and quality improvement. There is limited research regarding medical professionals’ acceptance of clinical-performance feedback and whether feedback impacts clinical practice. The objectives of our research were to (1) investigate aspects of A&F that impact physicians’ acceptance of performance feedback; (2) determine actions physicians take when receiving feedback; and (3) determine if feedback impacts physicians’ patient-management behavior.MethodsIn this qualitative study, we employed grounded theory methods to perform a secondary analysis of semi-structured interviews with 12 VA primary care physicians. We analyzed a subset of interview questions from the primary study, which aimed to determine how providers of high, low and moderately performing VA medical centers use performance feedback to maintain and improve quality of care, and determine perceived utility of performance feedback.ResultsBased on the themes emergent from our analysis and their observed relationships, we developed a model depicting aspects of the A&F process that impact feedback acceptance and physicians’ patient-management behavior. The model is comprised of three core components – Reaction, Action and Impact – and depicts elements associated with feedback recipients’ reaction to feedback, action taken when feedback is received, and physicians modifying their patient-management behavior. Feedback characteristics, the environment, external locus-of-control components, core values, emotion and the assessment process induce or deter reaction, action and impact.Feedback characteristics (content and timeliness), and the procedural justice of the assessment process (unjust penalties) impact feedback acceptance. External locus-of-control elements (financial incentives, competition), the environment (patient volume, time constraints) and emotion impact patient-management behavior. Receiving feedback generated intense emotion within physicians. The underlying source of the emotion was the assessment process, not the feedback. The emotional response impacted acceptance, impelled action or inaction, and impacted patient-management behavior. Emotion intensity was associated with type of action taken (defensive, proactive, retroactive).ConclusionsFeedback acceptance and impact have as much to do with the performance assessment process as it does the feedback. In order to enhance feedback acceptance and the impact of feedback, developers of clinical performance systems and feedback interventions should consider multiple design elements.

Towards an understanding of how appraisal of doctors produces its effects: a realist review

“…Our findings on the behaviour of the denial mechanism are consistent with Payne and Hysong's physician feedback model (i.e. non‐acceptance [or denial] of feedback tends to result in no behaviour modification) …”

“…Some elements of the whole programme theory are consistent with Payne and Hysong's physician feedback model (e.g. when doctors receive favourable feedback they feel a sense of pride and try to ensure performance is maintained, and non‐acceptance or denial of feedback results in no behaviour modification) …”

“…Similarly, part of Payne and Hysong's physician feedback model depicts a similar outcome (i.e. when doctors receive favourable feedback they feel a sense of pride and try to ensure performance is maintained) …”

“…when doctors receive favourable feedback they feel a sense of pride and try to ensure performance is maintained). 60…”

An Electronic Medical Record-Derived Individualized Performance Metric to Measure Risk-Adjusted Adherence with Perioperative Prophylactic Bundles for Health Care Disparity Research and Implementation Science

“…Irrefutable attribution is hence likely important for clinical acceptance of a performance metric. Together with procedural justice, the aforementioned characteristics have been shown to enhance physician responses to feedback 69. HypothesisOur hypothesis is that risk-adjusted adherence to established PONV guidelines can be leveraged for personalized visual feedback on the (equitable) performance of individual clinicians and to investigate health care delivery processes quantitatively.…”