Introduction
In an effort to improve clinical care and provide more quantitative
feedback to clinicians, the practice of audit and feedback (A&F) has
been implemented as a quality improvement (QI) initiative in many
clinical practice settings1. Systematic reviews have
demonstrated that the net effect of these interventions on overall
performance is small1 and that implementation for
selected measures is done ineffectively2. While the
literature on the implementation of best practices for A&F measures is
increasing3, the endpoints of clinical practice change
for end-users (physicians) is rarely assessed.
At present, there is very little guidance on how to use a refined A&F
tool that has been well implemented to the minds, hearts and behaviors
of physicians working in the clinical space. In other words, how do we
take what is known in the field of A&F and translate this into
meaningful practice change for practitioners? Many fields are currently
asking the same question. The proliferation of discussions around
clinical coaching4, expanded continuing professional
development (CPD) curricula, the inclusion of design thinking modalities
and the creation of peer learning spaces5–8 are all
indicative of a variety of “specialties” looking to answer the same
question.
In response, we sought to develop an understanding of how physicians
experienced the act of receiving practice data and develop a model that
describes how individuals may interact with the practice data that they
receive. Such a model would guide a series of different interventions
across a variety of data and ”readiness to change” environments. It may
also provide insights on how best to design data systems and how to
approach clinicians for change improvement within different data and
change contexts.