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Table 5 Forty-two high-confidence hypotheses from Clinical Performance Feedback Intervention Theory

From: 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

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]