Effective use of feedback for professional behaviour change and quality improvement in healthcare

Abstract

Background: This programme of research draws upon a number of case study feedback interventions to investigate and explore the psychological processes through which feedback contributes to professional behaviour change and quality improvement in healthcare. Methods: Case studies were selected based on operational need and opportunity. Semi-structured interviews were conducted with end users in order to take account of effectiveness for different stakeholders, acceptability to end users and unintended consequences. Analyses began inductively drawing upon the principles of grounded theory and proceeded to deductive reasoning where social psychological models, theories of behaviour change and the over-arching research questions were used to structure and interpret the analyses. Findings: Qualitative analysis of a large amount of interview data revealed a number of characteristics and psychological processes that can support the use of feedback for professional behaviour change in healthcare. A model for understanding these mechanisms will be presented. The integrated feedback and behaviour model provides an integrative understanding of how the desired output of professional behaviour change is influenced by intermediary outcomes (individual/group level learning and broader culture change) which themselves are the result of a number of psychological processes prompted by specific design features of feedback interventions. Discussion: This programme of research demonstrates that providing feedback is a complex, social, quality improvement intervention that cannot be fully explained by a simple, deterministic model. An improved understanding of these learning processes, along with recognition of complexity and context, will increase the contribution of feedback to professional behaviour change and quality improvement in healthcare.