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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]