The role of feedback in emergency ambulance services: a qualitative interview study

Abstract

Background Several international studies suggest that the feedback that emergency ambulance service (EMS) personnel receive on the care they have delivered lacks structure, relevance, credibility and routine implementation. Feedback in this context can relate to performance or patient outcomes, can come from a variety of sources and can be sought or imposed. Evidence from health services research and implementation science, suggests that feedback can change professional behavior, improve clinical outcomes and positively influence staff mental health. The current study aimed to explore the experience of EMS professionals regarding current feedback provision and their views on how feedback impacts on patient care, patient safety and staff wellbeing. Methods This qualitative study was conducted as part of a wider study of work-related wellbeing in EMS professionals. We used purposive sampling to select 24 frontline EMS professionals from one ambulance service in the United Kingdom and conducted semi-structured interviews. The data was analyzed in iterative cycles of inductive and deductive reasoning using Abductive Thematic Network Analysis. The analysis was informed by psychological theory, as well as models from the wider feedback effectiveness and feedback-seeking behavior literature. Results Participants viewed current feedback provision as inadequate and consistently expressed a desire for increased feedback. Reported types of prehospital feedback included patient outcome feedback, patient-experience feedback, peer-to-peer feedback, performance feedback, feedforward: on-scene advice, debriefing and investigations and coroners’ reports. Participants raised concerns that inadequate feedback could negatively impact on patient safety by preventing learning from mistakes. Enhancing feedback provision was thought to improve patient care and staff wellbeing by supporting personal and professional development. Conclusions In line with previous research in this area, this study highlights EMS professionals’ strong desire for feedback. The study advances the literature by suggesting a typology of prehospital feedback and presenting a unique insight into the motives for feedback-seeking using psychological theory. A logic model for prehospital feedback interventions was developed to inform future research and development into prehospital feedback.

Types and effects of feedback for emergency ambulance staff: a systematic mixed studies review and meta-analysis

“…35 Our own qualitative work on feedback to emergency ambulance staff found CP-FIT to have good face validity when exploring causal mechanisms at an abstract level, for example, 'processing and reflection'. 12 To identify potential mechanisms at a more detailed level for this review, we used behaviour change theory, which aims to identify active ingredients of interventions seeking to change behaviour 36 and has previously been used to synthesise evidence from audit and feedback interventions. 37 38 CW identified potential causal mechanisms deductively using an established list of mechanisms of action from behaviour change theory, 36 with a researcher experienced in behaviour change theory coding (RL) verifying the assigned codes of a 20% (n=10) random sample.…”

“…10-12 31 74 75 Concerns were that feedback was skewed towards the negative 10 75 and only triggered by highly traumatic incidents, 11 while EMS professionals desired routine, frequent and high-quality feedback. [10][11][12] One UK study suggested that EMS professionals desired 'pull'-type feedback, that is, initiated by individual clinicians, delivered electronically or involving staff mediators. 11 In addition to the feedback types identified in interventional studies (table 2), non-interventional studies also discussed patient experience feedback, which involved EMS…”

“…Extensive research has been conducted into the effects of feedback interventions within many healthcare settings; however, in 2012 relatively little work had been undertaken within EMS, as illustrated by the lack of EMS studies eligible for inclusion in the Cochrane review of audit and feedback. 5 Since then, a growing body of literature has been published on feedback within EMS suggesting that enhancing feedback and follow-up for EMS staff might improve clinical performance and staff well-being, [10][11][12] but this has not yet been synthesised comprehensively.…”

Patient, family member, and ambulance staff experiences of prehospital acute pain management in adults: A systematic review and meta‐synthesis

“… 54 This review highlighted a lack of clinician feedback, therefore ambulance clinician feedback systems should be implemented and maintained because previous research suggests clinical feedback may improve quality of care. 55 …”

“…Clinicians should be encouraged to treat pain more readily to meet patient needs and expectations, making full use of nonpharmacological techniques when appropriate and to use analgesics even when perceived to be weaker, thus harnessing the psychosocial effect of analgesic administration 54 . This review highlighted a lack of clinician feedback, therefore ambulance clinician feedback systems should be implemented and maintained because previous research suggests clinical feedback may improve quality of care 55 …”