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]