Disengagement with the purpose of data
Many clinicians were disengaged with the purpose of providing data and
engaging in A&F activities. Through an academic lens, some stated that
measuring adherence to practice standards through audit and feedback may
represent a complex to identify a “minimum standard” which should be
occurring in the clinical setting. Some respondents also identified that
certain remunerative environments may drive physicians to care more or
less about A&F data.
“Well there are a couple things, one is that it depends on how you’re
funded so if you’re salaried then it doesn’t really matter how many you
see. So, it really depends on […] if you are salaried or fee
for service.” [P14]
Through a gender lens, some female practitioners stated that they felt
that emergency medicine was a male dominated environment with largely
male leadership, leading to measurements and improvement targets that
may not resonate with women.
“Yeah, I think that it is a very male dominated environment. And most
of the staff are men, and the higher-ups are older white men. And there
is a very buddy buddy system.’ [P8]
Most respondents identified that participation in A&F must occur under
the pretext of being compatible to measurements established by the
practice group and department. If a practitioner feels they are “on the
outside” of the clinical group, their identification with the A&F data
would be less important.
“And you know sometimes what that leads to “is this isn’t the right
department for me”, but the question is does somebody want to keep
working in a department that isn’t respectful of them.” [P3]