Inside self‐regulation: peer review (visitatie) by Dutch medical specialists

Understanding how and why audits work: protocol for a realist review of audit programmes to improve hospital care

INTRODUCTION

Many types of audits are commonly used in hospital care to promote quality improvements. However, the evidence on the effectiveness of audits is mixed. The objectives of this proposed realist review are (1) to understand how and why audits might, or might not, work in terms of delivering the intended outcome of improved quality of hospital care and (2) to examine under what circumstances audits could potentially be effective. This protocol will provide the rationale for using a realist review approach and outline the method.

METHODS AND ANALYSIS

This review will be conducted using an iterative four-stage approach. The first and second steps have already been executed. The first step was to develop an initial programme theory based on the literature that explains how audits are supposed to work. Second, a systematic literature search was conducted using relevant databases. Third, data will be extracted and coded for concepts relating to context, outcomes and their interrelatedness. Finally, the data will be synthesised in a five-step process: (1) organising the extracted data into evidence tables, (2) theming, (3) formulating chains of inference from the identified themes, (4) linking the chains of inference and formulating CMO configurations and (5) refining the initial programme theory. The reporting of the review will follow the 'Realist and Meta-Review Evidence Synthesis: Evolving Standards' (RAMESES) publication standards.

ETHICS AND DISSEMINATION

This review does not require formal ethical approval. A better understanding of how and why these audits work, and how context impacts their effectiveness, will inform stakeholders in deciding how to tailor and implement audits within their local context. We will use a range of dissemination strategies to ensure that findings from this realist review are broadly disseminated to academic and non-academic audiences.

PROSPERO REGISTRATION NUMBER

CRD42016039882.

Evidence-based management in clinical governance

The aim of this paper is to describe a strategy--a partnership between a clinician manager and nurse academic--developed for the purpose of utilizing clinical governance literature to enhance management practice. The partnership is an initiative that has been implemented to fill a growing need for more collaboration between the tertiary health education and health industry sectors. The paper provides a brief overview of clinical governance and evidence-based management, and describes the partnership between the clinician manager and nurse academic. For the purposes of this paper 'clinician manager' refers to a health professional who also has an extensive management role in a health care organization. The benefits of this partnership in terms of the application of clinical governance literature to improved management decision making and practice concern the ability of clinician managers to have access to the most up-to-date research findings in terms of good clinical governance, and to be able to apply them in their management practice. Information about clinical governance, linked with evidence-based management and the application of clinical governance literature in the management of a health service is also provided. The authors argue that this is a useful initiative which could be adopted by health care managers and academics--with the aim of enhancing evidence-based management policy and decision making.

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).

DESIGN

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

SETTING

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.

INTERVENTION

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

MAIN MEASURES

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.