You can lead clinicians to water, but you can’t make them drink: the role of tailoring in clinical performance feedback to improve care quality

Desveaux, Laura; Rosenberg‐Yunger, Zahava R. S.; Ivers, Noah

doi:10.1136/bmjqs-2022-015149

Cited by 5 publications

(4 citation statements)

References 38 publications

(47 reference statements)

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“…Though the LTCQ team had been working with the site champions for close to 2 years at the time of this RCT, more time building relationships with the site champions may have mitigated skepticism and enhanced feedback acceptability [ 30 ]. The feedback reports were delivered to site champions via email and if we had also provided the opportunity for site champions to discuss the data with LTCQ staff, it may have supported the use of the feedback reports [ 31 ]. In our analysis of the overall project findings, a more intensive intervention which included coaching and frequent engagement with site champions and other staff was found to be more effective in increasing the proportion of eligible Veterans with completed LST templates [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of tailored audit with feedback in VHA long-term care settings

Kononowech,

Scott,

Landis-Lewis

et al. 2023

Implement Sci Commun

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Background The Long-Term Care QUERI program supported implementation of the Life-Sustaining Treatment Decisions Initiative in US Veterans Health Administration long-term care settings. The program worked with eleven Community Living Centers (CLCs) and twelve Home-Based Primary Care (HBPC) programs to increase rates of completed templates, using audit with feedback. We distributed monthly feedback reports to site champions showing the number of Veterans with appropriate documentation. Although feedback reports are a common implementation tool, little is known about the most effective ways to design, distribute, and support them. We sought to test tailoring reports with tips using site-specific data, as well as national comparator data. Methods We conducted a cluster randomized controlled trial of monthly feedback reports utilizing site-tailored tips and national comparator data compared to our original feedback reports that included only graphical and numerical data. CLC and HBPC team members were invited to participate in brief surveys each quarter to determine if they had received and used the feedback reports. The outcome for CLC residents was the percent with a completed LST template any time prior to the 14th day of their stay. The outcome for HBPC residents was the percent of Veterans with a completed LST template by their second HBPC visit. Results The response rate to the survey ranged between 6.8 and 19.3% of staff members across the CLC and HBPC sites with 12.8–25.5% of survey respondents reporting that they had seen the feedback reports. The linear regression models showed no significant association between receiving the enhanced feedback reports and having a higher documentation completion rate. Conclusions Receiving feedback reports tailored to sites by including tips based on baseline context assessments and qualitative findings, and reports showing national comparator data, did not have an impact on the number of Veterans with a completed LST template. Having a higher proportion of CLC or HBPC team members view the reports was not associated with an increase in LST template completion. These findings suggest that tailored audit with feedback may not have been effective at the program level, although the proportion of respondents who reported seeing the reports was small.

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Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of tailored audit with feedback in VHA long-term care settings

Kononowech,

Scott,

Landis-Lewis

et al. 2023

Implement Sci Commun

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“…As such tailoring is stimulated by the intervention, it may be more precisely referred to as tailoring of response, to distinguish it from tailoring of design and tailored delivery, where different participants or sites receive an intervention tailored to their characteristics [26,27].…”

Section: Pre-printmentioning

confidence: 99%

Enhancing the Irish National Audit of Dementia: An adaptation study

Sykes

O’Mahony

Wiggin

et al. 2023

Preprint

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Background: People with dementia in acute hospitals do not routinely receive best care. The Irish National Audit of Dementia was undertaken to improve care and is based upon the English National Audit of Dementia. Audit and feedback is an effective intervention, but there is variation in the extent to which it improves care. Increasing the quality improvement capabilities of feedback recipients may lead to greater improvements in care. We sought to adapt an existing quality improvement collaborative, to support the improvement capabilities of National Audit feedback recipients, to the Irish context. The study aimed to co-design adaptations to reflect contextual differences between the English and the Irish healthcare system and to explore fidelity, affective response, and reported appropriateness, burden and effectiveness of the adapted Quality Improvement Collaborative in Ireland. Methods: We used co-design methods involving dementia clinicians from three hospitals (n=7) and interviews with healthcare workers from seven hospitals (n=8) to adapt and explore implementation of the intervention. Results: The intervention required adaptation to reflect differences in: engagement, working patterns, terminology, the actors involved and organisational structure. There was evidence that the adapted intervention generated a positive affective response, was perceived as effective and appropriate and led to fidelity of receipt and enactment. Conclusion: We describe implications for the adaptation of interventions to increase participants’ quality improvement capabilities and highlight the importance of socio-adaptive work. We distinguish between adaptation and forms of tailoring. We propose further work to explore antecedents of senior positional leader engagement, to describe the delivery of intra-group behaviour change techniques and to adapt the intervention to other clinical domains.

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“…A good example here is clinician performance feedback interventions. We know that a ‘one size fits all’ approach is unlikely to succeed in most contexts, and we recently published a viewpoint that points to ways in which implementation science approaches such as tailoring can overcome this flaw 14. Ideally, these approaches will have generalisable lessons for our broad international audience even as they concentrate on local implementation.…”

Section: Moving the Field Forwardmentioning

confidence: 99%

“…We know that a 'one size fits all' approach is unlikely to succeed in most contexts, and we recently published a viewpoint that points to ways in which implementation science approaches such as tailoring can overcome this flaw. 14 Ideally, these approaches will have generalisable lessons for our broad international audience even as they concentrate on local implementation. For example, a recent Brazilian study of the patterns, appropriateness and outcomes associated with peripherally inserted central catheters demonstrated that assessment criteria and data collection methods previously used only in high-income countries could also be applied in a lower income setting.…”

Section: Implementing Solutions In Different Contextsmentioning

confidence: 99%

Our mission and how we hope to move the field forward: statement from theBMJ Quality & Safetysenior editorial team 2023

Browne,

Franklin,

Thomas

et al. 2023

BMJ Qual Saf

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You can lead clinicians to water, but you can’t make them drink: the role of tailoring in clinical performance feedback to improve care quality

Cited by 5 publications

References 38 publications

Randomized controlled trial of tailored audit with feedback in VHA long-term care settings

Randomized controlled trial of tailored audit with feedback in VHA long-term care settings

Enhancing the Irish National Audit of Dementia: An adaptation study

Our mission and how we hope to move the field forward: statement from theBMJ Quality & Safetysenior editorial team 2023

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