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The purpose of this paper is to investigate the acceptability and educational impact of independent feedback on the clinical audit performance of different groups of healthcare professionals by trained colleagues.

This is a pilot study involving review of the criterion audit and significant event analysis (SEA) attempts of west of Scotland dentists, pharmacists, physiotherapists, practice managers and nurse practitioners by trained colleagues using validated instruments. Audit, SEA and feedback reports were content‐analysed. Data on pre‐ and post‐study attitudes, experiences and knowledge levels were collected by questionnaire. T‐tests for differences in mean group scores were calculated, along with 95 per cent confidence intervals for mean differences. A difference in mean scores of 1.0 or greater would be indicative of educational gain.

A total of 34 participants submitted 54 audit and SEA reports, with 20 submitting both (58.9 per cent). In total, 14/20 audits (75.0 per cent) and 26/34 SEAs (76.5 per cent) contained evidence of appropriate learning needs and action(s) implemented for healthcare improvement. Feedback focused on knowledge and skills in applying audit methods; demonstrating insight into deficiencies; highlighting appropriate learning needs; and implementing change. Audit knowledge and skill scores increased by a mean difference of ≥1.0 for most stages of audit and SEA method (p<0.001). Strong agreement on the value of independent feedback on clinical audit was reported.

The study highlights some of the difficulties in applying audit methods across professions and highlights the added value of feedback by trained colleagues, but is limited in size.

Integrating clinical audit and peer feedback with continuing professional development obligations may facilitate greater engagement and more effective quality improvement, but will require a policy change and additional resource.

This small study provides further evidence of the acceptability and educational impact of independent feedback on clinical audit performance for healthcare professionals.

This paper synthesizes the extant feedback literature, focusing on how feedback affects an auditor’s learning, performance, and motivation. Performance feedback is an important component in the auditing environment for ensuring quality control and for developing and coaching staff auditors. However, the literature on feedback in the audit environment is fragmented and limited making it difficult to assess its behavioral effects on auditors. This paper has three main objectives. The first is to review some of the influential research in psychology and management to identify key variables and issues that appear to be critical in the study of behavioral consequences of feedback in organizational settings. The second is to review performance feedback research specifically in auditing to identify the areas previously examined and synthesize the findings. The third is to suggest a variety of future research opportunities that may assist in developing an understanding and knowledge of the behavioral effects of feedback on auditors. The literature analysis has significant implications for audit research and practice. In particular, the analysis provides important insights into understanding who, how, and when performance feedback should be given to improve its effectiveness in the audit environment.

The purpose of this paper is to investigate the effect of performance feedback and client importance on auditors' self‐ and public‐focused ethical judgments.

An experiment is conducted in which 71 auditors are assigned to one of four conditions created by fully crossing performance feedback (positive and negative) and client importance (high and low).

Consistent with expectations, auditors who receive positive (negative) feedback make more (less) ethical judgments in a self‐focused task (a judgment that produces consequences that are relevant for the auditor). Auditors also make more (less) ethical judgments in a public‐focused task (a judgment that has consequences for both the auditor and the public) when auditing a less (more) important client. Finally, auditors who receive positive feedback and audit a less important client make more ethical judgments in both tasks than all other auditors.

These findings suggest that auditors are susceptible to pressures from negative feedback and client importance, even in situations where their decisions will have public consequences, despite regulatory changes intended to enhance audit quality.

This is the first paper that provides evidence that different sources of pressure (performance feedback and client importance) differentially affect ethical tasks differing in decision consequences (self‐ and public‐focused). Such evidence suggests the importance of matching pressure source to ethical task type.

Purpose – Past literature suggests that the performance and turnover of the subordinate are affected by the support, abuse, and feedback provided by the supervisor. In this study, we posit that support, abuse, and feedback in an accounting firm, are in turn, affected by the supervisor's personality, as defined by the Big Five personality factors.

Methodology/approach – We conducted a web-based study with 115 accountants from a top 100 US accounting firm. The accountants completed questionnaires related to the personality of their supervisors along with questionnaires related to the support, abuse, and feedback they received from their supervisors. We analyzed the data using factor analysis and multiple regression.

Findings – We hypothesize that Openness and Agreeableness increase support; Neuroticism increases abuse, but less so if the supervisor is an Extravert; and Extraversion and Conscientiousness increase feedback. Among the hypothesized relationships, all are supported except the relationship between Openness and support. Additional findings are that Extraversion and Conscientiousness increase support; Agreeableness and Conscientiousness decrease abuse; and Agreeableness increases feedback.

Research implications – Our study contributes to the literature by demonstrating the relationship between the personality traits of supervisors and their behavior toward subordinates in an accounting setting. The results of our study can be used in identifying the supervisors who have the right personality for the position, which will likely improve the work environment and reduce turnover.

A large number of studies indicate that coercive forms of organizational control and performance management in health care services often backfire and initiate dysfunctional consequences. The purpose of this article is to discuss new approaches to performance management in health care services when the purpose is to support innovative changes in the delivery of services.

The article represents cross-boundary work as the theoretical and empirical material used to discuss and reconsider performance management comes from several relevant research disciplines, including systematic reviews of audit and feedback interventions in health care and extant theories of human motivation and organizational control.

An enabling approach to performance management in health care services can potentially contribute to innovative changes. Key design elements to operationalize such an approach are a formative and learning-oriented use of performance measures, an appeal to self- and social-approval mechanisms when providing feedback and support for local goals and action plans that fit specific conditions and challenges.

The article suggests how to operationalize an enabling approach to performance management in health care services. The framework is consistent with new governance and managerial approaches emerging in public sector organizations more generally, supporting a higher degree of professional autonomy and the use of nonfinancial incentives.

Audit and feedback (A&F) often underlie implementation projects, described as a circular process; i.e. an A&F cycle. They are widely used, but effect varies with no apparent explanation. We need to understand how A&F work in real-life situations. The purpose of this paper, therefore, is to describe and explore mental healthcare full A&F cycle experiences.

This is a naturalistic qualitative study that uses four focus groups and qualitative content analysis.

Staff accepted the initial A&F stages, perceiving it to enhance awareness and reassure them about good practice. They were willing to participate in the full cycle and implement changes, but experienced poor follow-up and prioritization, not giving them a chance to own to the process. An important finding is the need for an A&F cycle facilitator.

Research teams cannot be expected to be involved in implementing clinical care. Guidelines will keep being produced to improve service quality and will be expected to be practiced. This study gives insights into planning and tailoring A&F cycles.

Tools to ease implementation are not enough, and the key seems to lie with facilitating a process using A&F. This study underscores leadership, designated responsibility and facilitation throughout a full audit cycle.

Aims to show that audit and feedback could improve the prescribing of hormone replacement therapy (HRT) to women with a history of hysterectomy. Describes a randomised controlled trial involving 28 practices and covering a total of 3,169 women with a baseline coded history of hysterectomy. In addition to data extraction and feedback, intervention practices were given educational material and audit support. A rise in prescribing was evident in both younger and older women. There was also evidence of significant improvement in the appropriate prescribing of HRT. Concludes that prescribing feedback linked with educational material and audit can improve the prescribing of HRT in primary care in women with a history of hysterectomy and that this technique has wider application in the new era of clinical governance.

Patient safety remains a top priority in healthcare. Many organizations have developed systems to monitor and prevent harm, and have invested in different approaches to quality improvement. Despite these organizational efforts to better detect adverse events, efficient resolution of safety problems remains a significant challenge. The authors developed and implemented a comprehensive multimodal patient safety improvement program called SafetyLEAP. The term “LEAP” is an acronym that highlights the three facets of the program including: a Leadership and Engagement approach; Audit and feedback; and a Planned improvement intervention. The purpose of this paper is to evaluate the implementation of the SafetyLEAP program in the intensive care units (ICUs) of three large hospitals.

A comparative case study approach was used to compare and contrast the adherence to each component of the SafetyLEAP program. The study was conducted using a convenience sample of three (n=3) ICUs from two provinces. Two reviewers independently evaluated major adherence metrics of the SafetyLEAP program for their completeness. Analysis was performed for each individual case, and across cases.

A total of 257 patients were included in the study. Overall, the proportion of the SafetyLEAP tasks completed was 64.47, 100, and 26.32 percent, respectively. ICU nos 1 and 2 were able to identify opportunities for improvement, follow a quality improvement process and demonstrate positive changes in patient safety. The main factors influencing adherence were the engagement of a local champion, competing priorities, and the identification of appropriate resources.

The SafetyLEAP program allowed for the identification of processes that could result in patient harm in the ICUs. However, the success in improving patient safety was dependent on the engagement of the care teams.

The authors developed an evidence-based approach to systematically and prospectively detect, improve, and evaluate actions related to patient safety.

The purpose of this research is to ascertain whether there has been a change in the outcome of critically ill pregnant women from the indigent South African population from a clearly defined region in Pretoria, after the introduction of new management protocols supported by regular audit and feedback.

A comparison of outcome of all women with severe acute maternal morbidity or maternal deaths was made between 1997/1998 (original protocol) and 2002/2004 (new protocol) was performed.

It was found that there was a significant increase in the prevalence of critically ill pregnant women between 1997/1998 (8.40/1,000 births) and 2002/2004 (10.22/1,000 births; p<0.014), but a reduction in the MMR 133.2/100,000 births to 104.9/100,000 births (Odds Ratio 0.79, 95 Confidence Intervals 0.51 and 1.2) and in the mortality index from 15.9 per cent to 10.3 per cent (Odds Ratio 0.61, 95 per cent Confidence intervals 0.39 and 0.96). The pattern of primary obstetric causes of critically ill pregnant women has remained unchanged during the study period, but the prevalence of each disease category increased. The average number of dysfunctional organ systems per patient declined from 1.41 in 1997/1998 to 1.19 in 2002/2004. There were significant reductions in the number of critically ill pregnant women with renal dysfunction, metabolic dysfunction and cerebral dysfunction. The number of patient related, administrative related and medical personnel avoidable factors all decreased.

The new protocols, audit and feedback have been associated with a reduction in the number of preventable and manageable complications experienced by critically ill pregnant women over the past five years.

To organize stroke care, multiple stakeholders work closely together in integrated stroke care services (ISCS). However, even a well-developed integrated care program needs a continuous quality improvement (CQI) cycle. The current paper aims to describe the development of a unique peer-to-peer audit framework, the development model for integrated care (DMIC), the Dutch stroke care standard and benchmark indicators for stroke.

A group of experts was brought together in 2016 to discuss the aims and principles of a national audit framework. The steering group quality assurance (SGQA) consisted of representatives of a diversity of professions in the field of stroke care in the Netherlands, including managers, nurses, medical specialists and paramedics.

Auditors, coordinators and professionals evaluated the framework, agreed on that the framework was easy to use and valued the interesting and enjoyable audits, the compliments, feedback and fruitful insights. Participants consider that a quality label may help to overcome necessity issues and have health care insurers on board. Finally, a structured improvement plan after the audit is needed.

An audit offers fruitful insights into the functioning of an ISCS and the collaboration therein. Best practices and points of improvement are revealed and can fuel collaboration and the development of partnerships. Innovative cure and care may lead to an increasing area of support among professionals in the ISCS and consequently lead to improved quality of delivered stroke care.