Abstract
BackgroundThe potentials of audit and feedback (AF) to improve healthcare are currently not exploited. To unlock the potentials of AF, this study focused on the process of making sense of audit data and translating data into actionable feedback by studying a specific AF-case: limiting antimicrobial resistance (AMR). This was done via audit and feedback of AMR prevention measures (APM) that are executed by healthcare workers (HCW) in their day-to-day contact with patients. This study’s aim was to counterbalance the current predominantly top-down, expert-driven audit and feedback approach for APM, with needs and expectations of HCW.MethodsQualitative semi-structured interviews were held with sixteen HCW (i.e. physicians, residents and nurses) from high-risk AMR departments at a regional hospital in The Netherlands. Deductive coding was succeeded by open and axial coding to establish main codes, subcodes and variations within codes.ResultsHCW demand insights from audits into all facets of APM in their working routines (i.e. diagnostics, treatment and infection control), preferably in the form of simple and actionable feedback that invites interdisciplinary discussions, so that substantiated actions for improvement can be implemented. AF should not be seen as an isolated ad-hoc intervention, but as a recurrent, long-term, and organic improvement strategy that balances the primary aims of HCW (i.e. improving quality and safety of care for individual patients and HCW) and AMR-experts (i.e. reducing the burden of AMR).ConclusionsTo unlock the learning and improvement potentials of audit and feedback, HCW’ and AMR-experts’ perspectives should be balanced throughout the whole AF-loop (incl. data collection, analysis, visualization, feedback and planning, implementing and monitoring actions). APM-AF should be flexible, so that both audit (incl. collecting and combining the right data in an efficient and transparent manner) and feedback (incl. persuasive and actionable feedback) can be tailored to the needs of various target groups. To balance HCW’ and AMR-experts’ perspectives a participatory holistic AF development approach is advocated.
Highlights
The potentials of audit and feedback (AF) to improve healthcare are currently not exploited
To examine how including end-users in the early development process can improve AF strategies, this study focuses on a specific case where the potential added value of AF is large: preventing antimicrobial resistance (AMR) in hospitals
This paper focuses on the research question: What are healthcare workers (HCW)’ needs and expectations for future APMAF? By answering this question, we aim to better match the AMR prevention measures (APM)-expert’s and HCW’ perspectives to optimize future AF strategies, thereby increasing the likelihood of Antimicrobial resistance prevention measures audit and feedback (APM-AF) uptake and easier integration and use into practice [24]
Summary
The potentials of audit and feedback (AF) to improve healthcare are currently not exploited. To unlock the potentials of AF, this study focused on the process of making sense of audit data and translating data into actionable feedback by studying a specific AF-case: limiting antimicrobial resistance (AMR). This was done via audit and feedback of AMR prevention measures (APM) that are executed by healthcare workers (HCW) in their day-to-day contact with patients. Known barriers to successful AF are a lack of feedback to HCW, feedback solely focused on what went wrong and a poor follow-up in terms of continuous quality improvement cycles [6,7,8]. Thereby, the potential of AF as an improvement and learning strategy is foregone
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