Table 8 Where should intervention designers and evaluators direct their efforts and resources?
Stage | Lesson |
|---|---|
Selecting indicators | Consider fit with professional values, patient benefit and practice goals to enable a clear understanding of the need for something to be done differently and that improvement is possible Consider workload of reviewing patients near to targets (e.g. impact of stringent targets on patient preferences and rapport) and how this fits with achievement Ensure outcome measures are sensitive to efforts to improve achievement to enable learning from working to achieve change Limit the number of indicators and specify clear corrective actions or behaviours that will have impact on achievement Make visible individual contributions towards changing team-based behaviours and enable individuals to be accountable to themselves and their team |
When developing intervention components | |
Audit and feedback | Identify a named lead to coordinate the overall plan and individual actions Facilitate reach to those who are able to act to improve performance and suggest that feedback is made visible in the practice and at practice meetings Make clear relevance to non-clinicians Focus on feedback for learning in addition to feedback on performance (i.e. what could be done differently in addition to feedback on gap between actual and desired performance to support underachievers) Frame behaviour to showcase benefit of additional or modified ways of working (e.g. reduce unwanted actions (e.g. reduce risky prescribing or reduce strokes) as opposed to increase desired behaviours (e.g. increase prescription of anticoagulation)) Action plans that suggest specific and feasible actions could minimise cognitive load and overcome habitual patterns of working Consider reporting timeframe in relation to work to be undertaken. Estimate timeframes required for actions on action plans and time feedback accordingly Repeated negative feedback may be dispiriting and decrease ownership |
Educational outreach | Provide a time to review audit feedback and conduct patient-identifiable searches before meeting face-to-face to further explore barriers and goal setting Enrol all potentially relevant staff (e.g. administrative, managerial and clinical) as early as possible to create a sense of ownership and maximise time for improvement Create an open discussion of problems, how individuals work and ways to overcome challenges Ensure that the facilitator is seen as credible |
Reminders | Patient identifiable searches may reduce burden and enable practices to develop a continuous feedback loops to track and maintain improvements Ensure that searches and computerised prompts can be easily adapted to focus on practice targets for achievement Computerised prompts may be applicable to both clinical and administrative staff involved in repeat prescribing |
When delivering interventions | Establish commitment, rapport and mobilise resources prior to intervention delivery (e.g. time commitment, access to identifiable audit data) to increase awareness of intervention package Identify a practice lead who can empower participation and manage competing priorities Establish a team including management, clinicians and administrators to reinforce collective action Encourage rapid actions in intermediate process and outcomes to make progress visible and increase internal motivation to continuously improve Consider opportunities for social exchange of success stories of what others are doing |
When evaluating implementation components | Enable interactive communication between intervention developers and practices to support tailoring and adaptation of interventions to context Pilot test delivery, receipt and engagement as informed by NPT and TDF constructs before evaluating at scale |