Hypothesis: Feedback interventions are more effective when … | Relevant feedback cycle process(es) | Key explanatory mechanism(s) | Illustrative paper reference |
---|---|---|---|
Feedback variables | |||
Goal | |||
1. Importance: … They focus on goals recipients believe to be meaningful and often do not happen in practice. | Acceptance, Intention | Compatibility, Credibility | |
2. Controllability: … They focus on goals perceived to be within the control of the recipients. | Acceptance, Intention | Actionability | [62] |
3. Relevance: … They focus on goals perceived as relevant to recipients’ jobs. | Acceptance, Intention | Actionability, Compatibility, Relative advantage | [64] |
Data collection and analysis method | |||
4. Conducted by recipients: … They do not require the recipient to collect or analyse the clinical performance data. (Can also decrease 41. Cost) | Data collection and analysis | Complexity, Resource match | [67] |
5. Automation: … They collect and analyse data automatically rather than manually. | Data collection and analysis | Complexity, Resource match | [68] |
6. Accuracy: … They use data believed by recipients to be a true representation of their clinical performance. | Acceptance | Credibility, Relative advantage | [50] |
7. Exclusions: … They allow recipients to exception report patients they feel are inappropriate to include in their performance measurement. | Acceptance | Actionability, Credibility | [70] |
Feedback display | |||
8. Performance level: … They communicate recipients’ current performance has room for improvement. | Intention, Behaviour | Actionability, Compatibility | [64] |
9. Patient lists: … They show the details of patients used to calculate the recipients’ clinical performance. | Verification, Acceptance, Perception, Intention, Behaviour | Actionability Complexity Credibility | [50] |
10. Specificity: … They report the performance of individual health professionals rather than their wider team or organisation. | Acceptance, Intention, Behaviour | Actionability | [72] |
11. Timeliness: … They use recent data to calculate recipients’ current performance. | Acceptance, Intention, Behaviour | Actionability, Credibility | [50] |
12. Trend: … They show recipients’ current performance in relation to their past performance. (Can also increase 40. Observability) | Perception | Complexity, Relative advantage | [73] |
13. Benchmarking: … They compare recipients’ current performance to that of other health professionals, organisations or regions. | Perception, Intention, Behaviour | Complexity, Social influence | [74] |
14. Prioritisation: … They communicate the relative importance of feedback contents. | Perception | Complexity, Relative advantage | [55] |
15. Usability: … They employ user-friendly designs. (Can also increase 40. Observability) | Perception | Complexity | [82] |
Feedback delivery | |||
16. Function: … They are perceived to support positive change rather than punish suboptimal performance. | Acceptance | Compatibility | [85] |
17. Source knowledge and skill: … They are delivered by a person or organisation perceived to have an appropriate level of knowledge or skill. | Acceptance | Credibility, Social influence | [86] |
18. Active delivery: … They “push” feedback messages to recipients rather than requiring them to “pull”. (Except if solely delivered face-to-face, which increases 41. Cost) | Interaction | Compatibility, Complexity | |
19. Delivery to a group: … They deliver feedback to groups of recipients. | Perception, Intention, Behaviour (by increasing 28. Teamwork) | Social influence | [98] |
Recipient variables | |||
Health professional characteristics | |||
20. Feedback attitude: … They target health professionals with positive beliefs about feedback. | All | Compatibility, Relative advantage | [64] |
21. Knowledge and skills in quality improvement: … They target health professionals with greater capability in quality improvement. | Perception, Intention, Behaviour | Actionability, Complexity, Resource match | [91] |
22. Knowledge and skills in clinical topic: … They target health professionals with greater capability in the clinical topic under focus. | Perception, Intention, Behaviour | Actionability, Resource match | [92] |
Behavioural response | |||
23. Organisation-level and Patient-level behaviour: … Health professionals undertake changes involving the wider health care system rather than just individual patients in response to feedback. (Can also increase 24. Resource) | Clinical performance improvement | Actionability | [95] |
Context variables | |||
Organisation or team characteristics | |||
24. Resource: … Organisations and teams have greater capacity to engage with them. (Can also increase 23. Organisation-level behaviour) | All | Resource match | [98] |
25. Competing priorities: … Organisations and teams have minimal additional responsibilities. | All | Resource match, Compatibility | [90] |
26. Leadership support: … They are supported by senior managers. (Can also increase 23. Organisation-level behaviour) | All | Credibility, Resource match, Social influence | [87] |
27. Champions: … They are supported by individuals in the organisation dedicated to making it a success. | All | Credibility, Resource match, Social influence | [68] |
28. Teamwork: … They are implemented into organisations or teams whose members work together towards a common goal. | Perception, Intention, Behaviour | Actionability, Resource match, Social influence | [72] |
29. Intra-organisational networks: … They are implemented into organisations or teams with strong internal communication channels. | Interaction, Perception, Intention, Behaviour | Actionability, Compatibility, Resource match, Social influence | [51] |
30. Extra-organisational networks: … They are implemented into organisations or teams that actively communicate with external bodies. | Perception, Intention, Behaviour | Actionability Resource match | [86] |
31. Workflow fit: … They fit alongside existing ways of working. | All | Compatibility, Complexity | [64] |
Patient population | |||
32. Choice alignment: … They do not include patients who refuse aspects of care measured in the feedback in their calculations. | Acceptance, Intention | Actionability, Compatibility, Complexity | [105] |
33. Clinical appropriateness: … They do not include patients whose care cannot be safely optimised further. | Acceptance, Intention | Actionability, Compatibility, Complexity | [148] |
Co-interventions | |||
34. Peer discussion: … They encourage recipients discuss their feedback with peers. (Can also increase 28. Teamwork) | Perception, Intention | Complexity, Resource match, Social influence | [89] |
35. Problem solving: … They help recipients identify and develop solutions to reasons for suboptimal performance (or support recipients to do so). | Perception | Actionability, Compatibility, Complexity, Resource match | [90] |
36. Action planning: … They provide solutions to suboptimal performance (or support recipients to do so). | Intention, Behaviour | Actionability, Complexity, Resource match | [62] |
37. External change agents: … They provide additional staff to explicitly support its implementation. | All | Resource match | [94] |
Implementation process | |||
38. Adaptability: … They are tailored to the specific needs of the health care organisation and its staff. (Can also increase 31. Workflow fit) | All | Compatibility, Complexity | [69] |
39. Training and support: … They provide training and support regarding feedback (not the clinical topic under scrutiny). | Perception, Intention, Behaviour (by increasing 21. Knowledge and skills in quality improvement) | Actionability, Resource match | [91] |
40. Observability: … They demonstrate their potential benefits to recipients. | All | Relative advantage | [88] |
41. Cost: … They are considered inexpensive to deploy in terms of time, human or financial resources. | All | Resource match | [67] |
42. Ownership: … Recipients feel they “own” it, rather than it has been imposed on them. | All | Compatibility | [149] |