title: Observation for assessment of clinician performance: a narrative review.
abstract: BACKGROUND
  Video recorded and in-person observations are methods of quality assessment and monitoring that have been employed in high risk industries. In the medical field, observations have been used to evaluate the quality and safety of various clinical processes. This review summarises studies utilising video recorded or in-person observations for assessing clinician performance in medicine and surgery.
  
  
  METHODS
  A search of MEDLINE (PubMed) was conducted using a combination of medical subject headings (MeSH) terms. Articles were included if they described the use of in-person or video recorded observations to assess clinician practices in three categories: (1) teamwork and communication between clinicians; (2) errors and weaknesses in practice; and (3) compliance and adherence to interventions or guidelines.
  
  
  RESULTS
  The initial search criteria returned 3215 studies, 223 of which were identified for full text review. A total of 69 studies were included in the final set of literature. Observations were most commonly used in data dense and high risk environments, such as the emergency department or operating room. The most common use was for assessing teamwork and communication factors.
  
  
  CONCLUSIONS
  Observations are useful for the improvement of healthcare delivery through the identification of clinician lapses and weaknesses that affect quality and safety. Limitations of observations include the Hawthorne effect and the necessity of trained observers to capture and analyse the notes or videos. The comprehensive, subtle and sensitive information observations provided can supplement traditional quality assessment methods and inform targeted interventions to improve patient safety and the quality of care.
authors.affiliation: Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA.
authors.forename: Arianna F
authors.initials: AF
authors.lastname: Yanes
authors.affiliation: Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: McElroy
authors.affiliation: Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA.
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Abecassis
authors.affiliation: Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Holl
authors.affiliation: Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Woods
authors.affiliation: Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Daniela P
authors.initials: DP
authors.lastname: Ladner
mesh_terms: D002983:Clinical Competence; D003142:Communication; D006126:Group Processes; D019983:Guideline Adherence; D006739:Hospital Administration; D006801:Humans; D064887:Observational Studies as Topic; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D013647:Task Performance and Analysis; D014741:Video Recording
keywords: Human factors; Patient safety; Performance measures; Qualitative research; Quality measurement