Abstract
PurposeWhile the use of clinical feedback systems has become commonplace in psychological treatment, many of the most common instruments used for this purpose have not changed in decades. This paper describes the first four cycles of a measure development method designed to embrace continuous quality improvement.MethodsUsing techniques and philosophies developed in business management and academia—lean continuous quality improvement, action research, and practice research networks—we iterated through multiple cycles of development with the goal of creating an optimal clinical feedback system. These cycles emphasize building capacity to receive and implement feedback from a variety of stakeholders, especially patients and providers of behavioral health services, while also being responsive to quantitative findings from measure development.ResultsIterating measure development with stakeholder feedback over the course of 5 years has resulted in a novel measurement system with 19 subscales administered via branching logic, and a supporting practice research network to sustain development.ConclusionIn developing a new clinical feedback system, the less-frequently-discussed practical aspects of measure development require close attention. Specifically, being willing to embrace change, planning for iteration, and systematically seeking stakeholder feedback are identified as central methods for improving clinical feedback systems.
Highlights
One of the core principles of measure development is continuous evaluation and improvement [e.g. 1–4]
We have proposed that clinical feedback systems (CFS), widely used in mental health and substance use, have largely ignored continuous ongoing development, and have pointed out that the most widely used CFS measures have not changed for over a decade, despite the opportunity to learn and improve from feedback of their own—from their users [5]
Cronbach and Paul Meehl [7] point to this critical challenge for CFS developers: “One does not validate a test, but only a principle for making inferences” (p. 297)
Summary
One of the core principles of measure development is continuous evaluation and improvement [e.g. 1–4]. We have proposed that clinical feedback systems (CFS), widely used in mental health and substance use, have largely ignored continuous ongoing development, and have pointed out that the most widely used CFS measures have not changed for over a decade, despite the opportunity to learn and improve from feedback of their own—from their users [5]. This is important for CFS rather than other measurement tasks, Harvard School of Population Medicine, Boston, MA, USA 2 Weill Cornell Medical School, New York, NY, USA 3 District General Hospital of Førde, Førde, Norway 4 Department of Health and Caring Sciences, Western Norway. We describe the first four iterations of a continuous quality improvement (CQI) process as applied
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