Table 2 The CP-FIT feedback cycle components and associated interview questions
CP-FIT feedback cycle component | Definition | Interview question |
|---|---|---|
1. Goal setting | CP-FIT hypothesises that feedback is more effective when the clinical performance standards are considered important and relevant to recipients’ roles. | Are the standards of clinical performance clear? |
2. Data collection and analysis | Automated data collection and analysis processes are generally recommended. Manual collection and analysis are often hindered by a lack of time or skills. | Who does the data collection? |
3. Feedback | Current best evidence supports more frequent provision of feedback. Data should also be as recent as possible, which may enhance subsequent cycle components (Acceptance, Intention, and behaviour) and encourage identification of suboptimal performance. Other relevant factors include problem-solving and action planning, i.e. helping recipients identify and introduce solutions to improve. | What feedback is communicated? |
4. Interaction | This component includes the method of delivery and how recipients interact with the feedback, e.g. is it delivered directly to clinicians or do they need to seek it out? | How is the feedback received? |
5. Perception | Feedback is more effective when it is user-friendly. Provision of a comparator (e.g. showing performance benchmarked against appropriate others) is considered to facilitate the perception, Intention, and behaviour components. | How is the feedback understood? |
6. Verification | A potential component between perception and Acceptance where, if the feedback permits, recipients can explore the data underlying performance. | Can the recipients interrogate the data? |
7. Acceptance | Acceptance is facilitated when recipients believe the feedback presents a true representation of their performance. Users are more likely to engage with credible feedback, which facilitates several cycle components. | Is there Acceptance of the feedback? |
8. Intention | Ideally, recipients form Intentions to take actions to improve performance in response to the feedback. | Does the feedback elicit a planned response? |
9. Behaviour | Feedback that has been received, understood, and accepted will ideally be followed by a planned behavioural response. A distinction is made between patient-level responses, i.e. relating to the care of individuals, and those at the organisational-level with impacts across the wider healthcare system. | Is the behavioural response at patient or organisation level? |
10. Clinical performance improvement | Organisation-level behaviours are associated with greater clinical performance improvement potential as they enable multiple patient-led behaviours by enhancing the clinical environment in which they occur. | Are there positive changes to patient care as a result of feedback? |
11. Unintended consequences | CP-FIT acknowledges the potential for both positive and negative unintended outcomes of feedback interventions. Examples include improved record-keeping, or manipulation of patient populations to artificially improve performance, respectively. | Are there any unintended consequences as a result of the feedback? |