title: Feasibility of peer assessment and clinical audit to self-regulate the quality of physiotherapy services: a mixed methods study.
abstract: To evaluate the feasibility of a quality improvement programme aimed to enhance the client-centeredness, effectiveness and transparency of physiotherapy services by addressing three feasibility domains: (1) acceptability of the programme design, (2) appropriateness of the implementation strategy and (3) impact on quality improvement.
  
  
  
  Mixed methods study.
  
  
  
  64 physiotherapists working in primary care, organised in a network of communities of practice in the Netherlands.
  
  
  
  The programme contained: (1) two cycles of online self-assessment and peer assessment (PA) of clinical performance using client records and video-recordings of client communication followed by face-to-face group discussions, and (2) clinical audit assessing organisational performance. Assessment was based on predefined performance indicators which could be scored on a 5-point Likert scale. Discussions addressed performance standards and scoring differences. All feasibility domains were evaluated qualitatively with two focus groups and 10 in-depth interviews. In addition, we evaluated the impact on quality improvement quantitatively by comparing self-assessment and PA scores in cycles 1 and 2.
  
  
  
  We identified critical success features relevant to programme development and implementation, such as clarifying expectations at baseline, training in PA skills, prolonged engagement with video-assessment and competent group coaches. Self-reported impact on quality improvement included awareness of clinical and organisational performance, improved evidence-based practice and client-centeredness and increased motivation to self-direct quality improvement. Differences between self-scores and peer scores on performance indicators were not significant. Between cycles 1 and 2, scores for record keeping showed significant improvement, however not for client communication.
  
  
  
  This study demonstrated that bottom-up initiatives to improve healthcare quality can be effective. The results justify ongoing evaluation to inform nationwide implementation when the critical success features are addressed. Further research is necessary to explore the sustainability of the results and the impact on client outcomes in a full-scale study.
authors.affiliation: Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.|Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Marjo J M
authors.identifier: 0000-0002-9851-3108
authors.initials: MJ
authors.lastname: Maas
authors.affiliation: Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Maria W G
authors.initials: MW
authors.lastname: Nijhuis-van der Sanden
authors.affiliation: Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Femke
authors.initials: F
authors.lastname: Driehuis
authors.affiliation: Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.|Dutch Institute of Allied Healthcare, Amersfoort, The Netherlands.
authors.forename: Yvonne F
authors.initials: YF
authors.lastname: Heerkens
authors.affiliation: Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Cees P M
authors.initials: CP
authors.lastname: van der Vleuten
authors.affiliation: Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: van der Wees
mesh_terms: D000328:Adult; D054869:Clinical Audit; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010380:Peer Review / Q000379:methods*; D059825:Physical Therapists; D026741:Physical Therapy Modalities / Q000592:standards*; D011320:Primary Health Care; D058996:Quality Improvement; D011787:Quality of Health Care
keywords: Communication; Peer assessment; Record keeping; Self-assessment