Process evaluation of a tailored multifaceted feedback program to improve the quality of intensive care by using quality indicators.
BACKGROUND
In multisite trials evaluating a complex quality improvement (QI) strategy the 'same' intervention may be implemented and adopted in different ways. Therefore, in this study we investigated the exposure to and experiences with a multifaceted intervention aimed at improving the quality of intensive care, and explore potential explanations for why the intervention was effective or not.


METHODS
We conducted a process evaluation investigating the effect of a multifaceted improvement intervention including establishment of a local multidisciplinary QI team, educational outreach visits and periodical indicator feedback on performance measures such as intensive care unit length of stay, mechanical ventilation duration and glucose regulation. Data were collected among participants receiving the intervention. We used standardised forms to record time investment and a questionnaire and focus group to collect data on perceived barriers and satisfaction.


RESULTS
The monthly time invested per QI team member ranged from 0.6 to 8.1 h. Persistent problems were: not sharing feedback with other staff; lack of normative standards and benchmarks; inadequate case-mix adjustment; lack of knowledge on how to apply the intervention for QI; and insufficient allocated time and staff. The intervention effectively targeted the lack of trust in data quality, and was reported to motivate participants to use indicators for QI activities.


CONCLUSIONS
Time and resource constraints, difficulties to translate feedback into effective actions and insufficient involvement of other staff members hampered the impact of the intervention. However, our study suggests that a multifaceted feedback program stimulates clinicians to use indicators as input for QI, and is a promising first step to integrating systematic QI in daily care.
Scientific Center for Care and Welfare (Tranzo), Tilburg University, The Netherlands. m.l.g.devos@uvt.nl
L G
LG
de Vos Maartje
Sabine N
SN
van der Veer
Wilco C
WC
Graafmans
Nicolette F
NF
de Keizer
Kitty J
KJ
Jager
Gert P
GP
Westert
Peter H J
PH
van der Voort
D019985:Benchmarking / Q000379:methods*; D004502:Education, Medical, Continuing; D030141:Feedback, Psychological; D006293:Health Promotion; D006801:Humans; D007324:Institutional Management Teams; D007362:Intensive Care Units / Q000592:standards*; D008875:Middle Aged; D017146:Models, Organizational; D015279:Organizational Culture; D017064:Process Assessment, Health Care; D015397:Program Evaluation; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires; D017748:Time Management