ArticleBMC health services research2016
Model depicting aspects of audit and feedback that impact physicians' acceptance of clinical performance feedback.
Article in BMC health services research, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
32 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- A Systematic Review of Electronic Medical Record Driven Quality Measurement and Feedback Systems.International journal of environmental research and public health · 2022Pooled it
- An exploration into physician and surgeon data sensemaking: a qualitative systematic review using thematic synthesis.BMC medical informatics and decision making · 2022Pooled it
- Clinical Performance Feedback Intervention Theory (CP-FIT): a new theory for designing, implementing, and evaluating feedback in health care based on a systematic review and meta-synthesis of qualitative research.Implementation science : IS · 2019Pooled it
- Process outcomes of a multifaceted, interdisciplinary knowledge translation intervention in aged care: results from the vitamin D implementation (ViDAus) study.BMC geriatrics · 2019Trial
- Who chooses to engage? Understanding the characteristics of physicians who voluntarily engage with an audit and feedback intervention: a retrospective cohort study.BMJ quality & safety · 2026Article
- Utilisation of a cocreation methodology to develop claims-based indicators for feedback on implementation of comparative effectiveness research results into practice.BMJ open quality · 2025Article
- Physician perspectives of clinical performance feedback and impact on well-being: a qualitative exploration.BMJ open · 2024Article
- Designing Communication Feedback Systems To Reduce Healthcare Providers' Implicit Biases In Patient Encounters.Proceedings of the SIGCHI conference on human factors in computing systems. CHI Conference · 2024Article
- Do medical specialists accept claims-based Audit and Feedback for quality improvement? A focus group study.BMJ open · 2024Article
- A realist synthesis of multicentre comparative audit implementation: exploring what works and in which healthcare contexts.BMJ open quality · 2024Review
- Snakes and ladders: A qualitative study understanding the active ingredients of social interaction around the use of audit and feedback.Translational behavioral medicine · 2023Article
- Electronic Health Records That Support Health Professional Reflective Practice: a Missed Opportunity in Digital Health.Journal of healthcare informatics research · 2022Article
- 'Give me something meaningful': GPs perspectives on how to improve an audit and feedback report provided by health insurers - an exploratory qualitative study.BMJ open quality · 2022Article
- Increasing the Amount and Intensity of Stepping Training During Inpatient Stroke Rehabilitation Improves Locomotor and Non-Locomotor Outcomes.Neurorehabilitation and neural repair · 2022Article
- The voice of the self: a typology of general practitioners' emotional responses to situational and contextual stressors.Scandinavian journal of primary health care · 2022Article
- Battling Bias in Primary Care Encounters: Informatics Designs to Support Clinicians.Extended abstracts on Human factors in computing systems. CHI Conference · 2022Article
- Benefits of Providing Feedback and Utilisation Metrics to Specialists on Their Participation in eConsult.Journal of European CME · 2022Article
- Use of prescribing safety quality improvement reports in UK general practices: a qualitative assessment.BMC health services research · 2021Article
- Impact and feasibility of a tailor-made patient communication quality improvement programme for hospital-based physiotherapists: a mixed-methods study.BMJ open quality · 2021Article
- Unpacking the intention to action gap: a qualitative study understanding how physicians engage with audit and feedback.Implementation science : IS · 2021Article
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
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.
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