Existence of self-data feedback loops
Many respondents reflected on how the data would make them feel about themselves and how it might drive them to change their behavior or practice. Many endorsed a level of curiosity about quantitative measures of their practice- some of which supported the use of data for validation of good practices. Some physicians acknowledged that some positive data would be attributed to team performance rather than individual physician performance.
“Maybe they already know that they are doing a great job and they just want to be validated some more.” [P8] “So good practice feedback. I think that would be reaffirming for them but also, they may kind of shrug it off as I am just a part of the team.” [P4]
Others raised important insights into the consequences of data feedback that may be viewed as negative by the recipient. They highlighted that the risk of these could be inappropriate remedial actions to improve data metrics or that the data may be seen as a value judgement on their character. They also stated that these may conflict with their own image of themselves, forcing some reflection.
”Yeah so, I think that they would um, see it as a value judgement on their character. And so, may not be as open if it is not congruent with their philosophy on how (they are) part of the team. And also, how they are for this overall community of the emergency department.” [P7]
While recognizing this potential, many respondents reflected that the act of acquiring practice data would lead to an ongoing assessment of personal practice as well as the identification of areas where there is a large potential for improvement. This could lead to a deeper understanding of negative performance in these clinical areas.
“And so, I think [..] physicians recognize that there are always going to be areas in their practice that you know have a broad ability to improve” [P5] “ And we might imagine that the utility will be less because we I think probably mistakenly assume that we have little to learn. When in fact my guess is probably that we can learn a lot.” [P15]
In many cases, there was a clear focus on elements of quality of care rather than simply throughput metrics, which represent a thoughtful prioritization of A&F metrics. Personal improvement loops centered on elements of quality of care are enabling attributes in A&F.
“[..] or maybe they value more the spending time and communicating better with their patients then the just sheer volume of patients seen per shift. … maybe they value you know better care for patient care than volume. And that is a different way to look at things.” [P2]