ArticleBMJ open2023
Walking the line between assessment, improvement and learning: a qualitative study on opportunities and risks of incorporating peer discussion of audit and feedback within quality improvement in general practice.
Article in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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Who cites it
4 citing papers in PubMed.
- Advancing learning health care systems with best practice meetings: a mixed-methods study with insights from the Dutch Institute for Clinical Auditing.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026Article
- Contextual Factors Affecting Evidence-Based Practice in Orthopaedic Nursing and Rehabilitation: A Mixed Methods Study.Journal of advanced nursing · 2026Article
- Beyond Compliance: Understanding the Role of Peer Review Through a Theory of Change.Journal of evaluation in clinical practice · 2026Article
- An Organizational Case Study of Mental Models among Health System Leaders during Early-Stage Implementation of a Population Health Approach.Journal of healthcare leadership · 2024Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThere is a broad call for change towards 'new era' quality systems in healthcare, in which the focus lies on learning and improving. A promising way to establish this in general practice care is to combine audit and feedback with peer group discussion. However, it is not known what different stakeholders think of this type of quality improvement. The aim of this research was to explore the opinions of different stakeholders in general practice on peer discussion of audit and feedback and on its opportunities and risks. Second, their thoughts on transparency versus accountability, regarding this system, were studied.
designAn exploratory qualitative study within a constructivist paradigm. Semistructured interviews and focus group discussions were held and coded using thematic analysis. Included stakeholders were general practitioners (GP), patients, professional organisations and insurance companies.
settingGeneral practice in the Netherlands.
participants22 participants were purposively sampled for eight interviews and two focus group discussions.
resultsThree main opportunities of peer discussion of audit and feedback were identified: deeper levels of reflection on data, adding context to numbers and more ownership; and three main risks: handling of unwilling colleagues, lacking a safe group and the necessity of patient involvement. An additional theme concerned disagreement on the amount of transparency to be offered: insurance companies and patients advocated for complete transparency on data and improvement of outcomes, while GPs and professional organisations urged to restrict transparency to giving insight into the process.
conclusionsPeer discussion of audit and feedback could be part of a change movement, towards a quality system based on learning and trust, that is initiated by the profession. Creating a safe learning environment and involving patients is key herein. Caution is needed when complete transparency is asked, since it could jeopardise practitioners' reflection and learning in safety.
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Registered trials
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