KT Tool Review: Audit & Feedback

How to advance a growing — yet somewhat stagnant — field of research

CHI KT Platform
Nov 28, 2018 · 7 min read

Audit and feedback research is a “massive field, and it’s growing fast.”

That’s Dr. Noah Ivers of the Women’s College Research Institute speaking at a June 2018 Choosing Wisely Canada talk, which you can watch here.

https://choosingwiselycanada.org/event/2018junetalk/

What is Audit and Feedback?

In short, Audit and Feedback (A&F) is the process of measuring an individual’s professional performance and reporting their results back to them within context (e.g. in comparison to their peer group, or desired standards).

A Languishing Literature

Back to Ivers and his A&F talk — he adds “although it’s a growing literature, it’s a stagnant literature.” If you’re like me, your ears just perked up.

The Audit & Feedback Echo Chamber

Here’s a common situation in health research and/or quality improvement in healthcare:

Source: https://giphy.com/gifs/modern-family-thumbs-up-phil-dunphy-geYwtodB9AiI0

“The explicit use of theory in studies of audit and feedback [is] rare.”

Of all the 140 studies reviewed, only 14 per cent reported use of a theory, and only 9 per cent used a theory to inform development of the intervention. [1]

“This is a problem. This is people doing stuff and evaluating it in trials, but not necessarily taking advantage of the opportunity to help everybody else learn how to do things better.”

Source: https://giphy.com/gifs/family-dunphy-wifflegif-fxwKMXHxeIn8k

Learning to Do Things Better

In 2014, Dr. Ivers and his team published a debate article providing guidance on creative ways to improve A&F implementation research, including:

  • Applying “relevant theory to improve design and increase contribution to the literature,” (such as the Theoretical Domains Framework) and;
  • Manipulating intervention components within real-world constraints (e.g. using multiple interventions to address specific barriers and facilitators where feedback alone is unlikely to change behaviour). [2]
  1. Nature of the data available for feedback (e.g. provided ASAP and in multiple instances)
  2. Feedback display (e.g. “minimize extraneous cognitive load for feedback recipients” — reduce the mental effort required to process and respond to feedback)
  3. Delivering the feedback intervention (e.g. “prevent defensive reactions to feedback”) [3]
Photo by Sam McGhee on Unsplash

These themes — and more specifically, the hypotheses associated with them — form an incredibly clear set of directions upon which to build comparative effectiveness studies using A&F.

Colquhoun et al. note that “the number of potential hypotheses identified and the range of theories and theoretical concepts discussed underscores the complexity and number of potential mechanisms underlying effective A&F.”

  • How can we best engage end-users in the intervention design process to avoid pushback?
  • Does making practitioners sign a commitment to the A&F process improve the sustainability of positive intervention effects?

Audit & Feedback and the Art of the Nudge

For those who’ve read my other posts, you know I’m going to try to find an angle to work the art of nudging into the conversation (if you’re not familiar with the term, you can read about it in my post, Automatically Smarter).

Source: https://www.health.org.uk/publications/behavioural-insights-in-health-care p. 42

Before you Implement Audit & Feedback

The next time you or somebody you know is about to embark on an audit & feedback project, take a look at the testable hypotheses embedded in the work above. Try to incorporate some or all of the best practices mentioned into the design and development of the intervention. Opt for a research design that allows you to compare the effectiveness of two or more different solutions, and not just against a standard control.



About the Author

Patrick Faucher is the Creative & Strategic Services Lead for the George and Fay Yee Centre for Healthcare Innovation’s Knowledge Translation platform. A communications strategist with over a dozen years experience, he specializes in creating content engineered to build awareness, understanding, engagement, and adoption through an approach rooted in design thinking (rapid prototyping) and behavioural insights (nudging).

KnowledgeNudge

Publishing bi-weekly, we focus on all things knowledge translation (KT) – synthesis, exchange, application & dissemination – from a health perspective. Topics include the science of KT, patient engagement, and media & dissemination.

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Know-do gaps. Integrated KT. Patient & public engagement. KT research. Multimedia tools & dissemination. And the occasional puppy.

KnowledgeNudge

Publishing bi-weekly, we focus on all things knowledge translation (KT) – synthesis, exchange, application & dissemination – from a health perspective. Topics include the science of KT, patient engagement, and media & dissemination.