Clinical performance feedback and quality improvement opportunities for perioperative physicians

Figures & data

Table 1 Summary of major findings for effectiveness of feedback and performance measurement

Reference	Year	Effect of feedback	Major findings
Ende^Citation8	1983	A seminal article that offering feedback strategies set forth in the literature of business, psychology, and education.	Once the distinction between feedback and evaluation is made and the importance of focusing on the trainees’ observable behaviors rather than on the trainees themselves is recognized, the educational benefit of feedback can be realized.
Mugford et al^Citation35	1991	Feedback of information influences clinical practice if it is part of an overall strategy, and targets decision-makers who have already agreed to review their practice.	Feedback is likely to have a more direct effect on practice when presented close to the time of decision-making.
Veloski et al^Citation32	2006	41 studies evaluated the independent effect of feedback, 32 of which demonstrated a positive impact on physician performance.	Concluded that feedback can improve physician’s performance when provided systematically by an authoritative credible source over an extended period of time (ie, multiple years).
Glance et al^Citation11	2011	Provides a historical perspective on the evolution of feedback data within the field of anesthesia.	The Donabedian structure–process–outcome conceptual model can be used to address the strengths and limitations of performance measurement. “Quality” of quality measurement (based on outcomes) is a function of data quality, risk adjustment, sample size, and the accuracy of the outcomes themselves.
Overeem K^Citation29	2012	Reiterates the global need to assess physicians’ professional performance in actual clinical practice. Suggests that valid and reliable instruments are necessary to support these efforts.	Demonstrated that three multisource feedback instruments produced reliable and valid data for evaluating physicians’ professional performance in the Netherlands. Scores from peers, coworkers, and patients were not correlated with self-evaluations. Future research should examine improvement of performance when using multisource feedback.

Table 2 Major premises of integrating feedback and establishing a culture for physician improvement

• Physician feedback should be part of a broader quality improvement initiative.

• Improving physician practice and behavior through a variety of mechanisms including feedback does ultimately improve patient care and overall satisfaction.

• Feedback is more readily embraced and embedded within a department’s culture when viewed as part of physicians’ lifelong learning.

• Within the academic setting, senior leaders and stakeholders must be involved in the development of the feedback process.

• Those involved with the feedback process should be properly trained on how best to give constructive, supportive feedback without fear of an antagonistic reaction from the recipient.

• Feedback is best when it detects problems early, provides information in real time, and focuses on goal-oriented behavior.

• Feedback data instruments should cater to both the needs of the group and what works best for the individual. There is no “one-size fits all” approach; nevertheless, this does not preclude the importance of and need to implement a strategy going forward.

EndeJFeedback in clinical medical educationJAMA19832507777816876333

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MugfordMBanfieldPO’HanlonMEffects of feedback of information on clinical practice: a reviewBMJ19913033984021912809

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VeloskiJBoexJRGrasbergerMJEvansAWolfsonDBSystematic review of the literature on assessment feedback and physicians’ clinical performance: BEME Guide No 7Med Teach20062811712816707292

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GlanceLGNeumanMMartinezEAPaukerKYDuttonRPPerformance measurement at a “tipping point”Anesth Analg201111295896621385976

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OvereemKDoctor performance assessment: development and impact of a new systemPerspect Med Educ2012129810023316465

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