University of Twente Student Theses


Improving the development and implementation of audit-and-feedback-systems for healthcare workers’ performance practices: a mixed-method study

Bente, Britt E. (2019) Improving the development and implementation of audit-and-feedback-systems for healthcare workers’ performance practices: a mixed-method study.

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Abstract:Background: The incidence of healthcare associated infections (HAI) has increased over the years. To enable healthcare workers to follow the infection prevention and control recommendations for HAI, audit-and-feedback systems (AFS) have been developed for monitoring of healthcare workers’ performance practices. Studies demonstrate that AFS have positive effects in changing the behaviour of healthcare workers and improving patient outcomes. However, current development of AFS often lacks identifying stakeholders’ and contextual needs and characteristics during development, which results in the occurrence of hindrances after implementation. To create an optimal fit between the user, AFS and context, it is necessary to involve stakeholders throughout development and implementation of AFS. Objectives: To identify which elements can improve the development and implementation of AFS intended to improve healthcare workers’ performance practices Methods: A mixed method study was performed, which combined a scoping review and conducting interviews, aiming to investigate current practices of existing AFS and healthcare workers’ needs for and experiences with AFS. A total of 24 studies were selected, which contain information about technological AFS strategies or interventions. Data related to the design, implementation and usage in practice of AFS were extracted. To gain insight into needs and experiences of healthcare workers, semi-structured interviews were conducted with nine respondents from six hospitals. Results: Respondents indicated several requirements related to the design, implementation and usage in practice of AFS. Design requirements include system functionalities (e.g. utilizing reminders, addressing knowledge gaps, measuring outcomes continuously and a user-friendly design) but also explored the wish for tailored feedback (e.g. feedback should be positive, nonthreatening, supportive and needs further explanation). Furthermore, AFS should provide a visualisation of data and direct access to feedback. Implementation requirements include the integration of AFS with other existing systems or protocols. Other indicated enablers for implementation are the assignment of those responsible for AFS, employing a bottom-up strategy and providing training and test moments. Barriers for implementation include a negative feeling of being judged by AFS. For the usage of AFS in daily practice, a positive attitude is required (determined by e.g. healthcare workers’ engagement with AFS and their belief in the value and trustworthiness of AFS). Barriers include negative attitudes (determined by e.g. disbelief in AFS usefulness) and healthcare workers’ resistance to utilise AFS. Discussion and conclusion: In order to improve the development and implementation of AFS, AFS should be user-friendly, continuously collecting data and connect with other systems; additionally, feedback should be tailored, and it is valued to utilise reminders. Recommendations to encourage an optimal fit between the user, AFS and context include the following: implement a bottom-up approach (active healthcare workers involvement) with top-down stimulation (supervisor support); and provide training and test possibilities to gain a better knowledge about AFS and the expectations of healthcare workers. Because every user, technology and context is different, it is crucial to consider the influence of characteristics of users and their context in the design and implementation of AFS. Future research should study the effects of a bottom-up approach in the hospital setting. Keywords: Audit-and-feedback system, Healthcare Associated Infections, Performance improvement Patient Safety, Quality Improvement
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:01 general works, 44 medicine, 70 social sciences in general
Programme:Health Sciences MSc (66851)
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