Measuring the perceived impact of facilitation on implementing recommendations from external assessment: lessons from the Dutch visitatie programme for medical specialists.
OBJECTIVE
To evaluate the impact of facilitation by management consultants on implementing recommendations from external quality assessment (visitatie).


METHODS
Data collection through a postal survey amongst 205 medical specialists, representing 50 hospital-based specialist groups in the Netherlands.


METHODS
Under the auspices of the specialty societies of surgeons, paediatricians and gynaecologists, 25 groups were offered approximately 20 h of management consulting to support the implementation of recommendations for quality improvement and were compared to 25 specialist groups not receiving the support.


METHODS
The Quality Consultation (QC) took a site-specific multifaceted implementation approach.


METHODS
Self-reported degree of implementation of recommendations, specialists' judgement of implementation result and process; experienced obstructing factors in implementing recommendations.


RESULTS
The response rate was 54% (n = 110). The supported specialist groups were more successful in partially or fully implementing the recommendations from external peer assessment: 66.1% vs. 53.8%. The implementation result and process were also rated significantly higher for the supported groups. The supported groups reported significantly less (P < 0.005) obstructing factors; in particular for the barriers 'expectation of implementation advantages', 'acceptance of the recommendations' and 'assessed self-efficacy'. The experienced obstructing factors are strongly related with the degree of implementation (spearman rho 0.57-32.5%).


CONCLUSIONS
This study suggests QC is a powerful implementation strategy. It also shows the limitations of merely quantitatively analysing multifaceted strategies: it does not offer any insight into the 'black box' of the QC. It is recommended that these limitations are met by also exploring multifaceted strategies qualitatively.
Lombarts
M J M H Kiki
MJ
University of Amsterdam, Academic Medical Center, Department of Social Medicine, Amsterdam, the Netherlands. K.Lombarts@hetnet.nl
Klazinga
N S Niek
NS
Redekop
K Ken
KK
D003253:Consultants; D003625:Data Collection; D004059:Diffusion of Innovation; D008511:Medicine / Q000592:standards*; D009426:Netherlands; D011785:Quality Assurance, Health Care; D013038:Specialization