Audit and group feedback in nursing home physician groups: lessons learned from a qualitative study

Area of Science:

• Healthcare quality improvement
• Medical education
• Health services research

Background:

• Audit and group feedback (A&F) is a method to enhance healthcare professional performance.
• Sessions involve auditing clinical practice against criteria and providing group feedback facilitated by an expert.
• This study investigated the conduct and action planning outcomes of physician group feedback in nursing homes.

Purpose of the Study:

• To understand the process of physician group feedback sessions in nursing homes.
• To evaluate the extent to which these sessions lead to action planning for quality improvement.

Main Methods:

• Fifteen antibiotic Audit and group feedback sessions in a nursing home network were audio-recorded.
• Transcripts were analyzed using the Framework Method for thematic analysis.
• Analysis incorporated the Calgary A&F Framework and Cooke's model of physician behaviors, with added open inductive codes.

Main Results:

• All sessions included elements of the conceptual model and Calgary A&F Framework.
• Group dynamics and facilitator interactions were key to translating feedback into action plans.
• Physician responses to audit data varied; some embraced positive results, while others questioned data accuracy or cited external factors for non-adherence.
• The extent of reflection and action planning differed, with some groups developing immediate plans and others scheduling follow-ups.

Conclusions:

• Facilitators play a vital role in guiding result interpretation, promoting discussion of change, and aiding action plan development.
• The level of participant reflection and subsequent action planning varied significantly across groups.
• Refining group feedback sessions based on these findings can enhance their effectiveness in supporting physician action planning and improving care quality.