title: Measuring the perceived impact of facilitation on implementing recommendations from external assessment: lessons from the Dutch visitatie programme for medical specialists.
abstract: 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.
authors.affiliation: University of Amsterdam, Academic Medical Center, Department of Social Medicine, Amsterdam, the Netherlands. K.Lombarts@hetnet.nl
authors.forename: M J M H Kiki
authors.initials: MJ
authors.lastname: Lombarts
authors.forename: N S Niek
authors.initials: NS
authors.lastname: Klazinga
authors.forename: K Ken
authors.initials: KK
authors.lastname: Redekop
mesh_terms: D003253:Consultants; D003625:Data Collection; D004059:Diffusion of Innovation; D008511:Medicine / Q000592:standards*; D009426:Netherlands; D011785:Quality Assurance, Health Care; D013038:Specialization