Noah Ivers – Obstacles affecting A&F in the health system – 25 novembre 2021

Obstacles affecting A&F in the health system | Fouth online meeting | November 25th | Time: 3:30-5.15 (CET)

15.40 –  Noah Ivers,  University of Toronto

Obstacles affecting A&F in the health system 

Understanding how well a clinician, or health care team is performing provides an essential foundation for improvement. When done well, audit and feedback (A&F) provides data in a non-judgemental, motivating fashion and leads to changes in clinical processes that benefit patients. This talk will explore obstacles to optimizing the potential positive effects of A&F to improve patient care and outcomes by examining three inter-related steps in the process: the audit; the feedback; and the action. The audit requires data that will be perceived as both valid and actionable. Acquiring and using such data properly often requires partnerships. The recipients must also know how to turn the data into action. The A&F should include components that direct the recipient toward feasible next steps. Such actions can be personal (learning new diagnostic or treatment strategies, trying harder on a patient-by-patient basis), or organizational (more proactive approaches that often feature additional team members). The ability to turn feedback into action will depend on the culture of the recipient-group and their QI-literacy. Feedback facilitation or coaching may be needed for certain groups or certain kinds or desired changes in practice. Inadequate leadership and support for health professionals as they try to respond to A&F is, therefore, another key obstacle.

Key readings 

There are many papers relevant to this brief talk, some of them are highlighted here:

• Importance of reliable data for the audit
  Kroenke K, Talib TL, Stump TE, et al. Incorporating PROMIS Symptom Measures into Primary Care Practice-a Randomized Clinical Trial. J Gen Intern Med. 2018;33(8):1245-1252. doi:10.1007/s11606-018-4391-0
• Role of partnerships
  Grimshaw JM, Ivers N, Linklater S, et al. Reinvigorating stagnant science: implementation laboratories and a meta-laboratory to efficiently advance the science of audit and feedback. BMJ Qual Saf. 2019;28(5):416-423. doi:10.1136/bmjqs-2018-008355
• Positive perception of feedback is a precursor to action
  Desveaux L, Ivers NM, Devotta K et al. Unpacking the intention to action gap: a qualitative study understanding how physicians engage with audit and feedback. Implementation Sci16, 19 (2021). https://doi.org/10.1186/s13012-021-01088-1
• Many other key papers and resources are available here: http://www.ohri.ca/auditfeedback/resources/