Table 4 Stage 3 feedback for an implementation model

Make audit design a collaboration between clinicians at diverse hospitals (to ensure local constraints are factored in) and external agencies (to give objective “big picture” input and standardisation across hospitals) to increase acceptance and ownership of audit measures for each site. Clearly communicate the purpose of each measure

One key challenge for clinicians is when audit and feedback is an addition to current workloads rather than a part of practice. We can capture information well in routine workflows. However, we can’t necessarily capture knowledge, as this is qualitative. Scientific rigor of audits is important to ensure sample size and questions are right; otherwise, it can stand in the way of improvement efforts. Clinicians dismiss based on small sample sizes and when they aren’t involved. If the feedback is from an external source, it can be dismissed by clinicians. If clinicians don’t like the audit process, then they can disengage, even if the information might be potentially useful