Goals & Feedback

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Goals & Feedback
Taxonomy
Domain
Inner Setting
Construct
Implementation Climate
Siblings
Compatibility
Goals & Feedback
Learning Climate
Organizational Incentives & Rewards
Relative Priority
Tension for Change
Measurement maturity
Quantitative tools


Contents

Version 1.0

The degree to which goals are clearly communicated, acted upon, and fed back to staff and alignment of that feedback with goals.

Description

The degree to which goals are clearly communicated, acted upon, and fed back to staff and alignment of that feedback with goals[1][2][3]. The Chronic Care Model emphasizes the importance of relying on multiple methods of evaluation and feedback including clinical, performance, and economic evaluations and experience[4].

Rationale for inclusion

The degree to which goals are clearly communicated, acted upon, and fed back to staff and alignment of that feedback with goals[1][2][3][5][6][7]. An important feature of many individual behavior change models is setting goals and receiving feedback on progress[5]. A recent review found that effects of using audit and feedback mechanisms to improve practices resulted in small to moderate effects[6]. However, studies showed wide variation of effects and little is known about appropriate methods. In addition, nothing was said about how those audit and feedback methods aligned with larger organizational mission and goals. Stakeholders cannot take corrective action without sufficient feedback that is tightly coupled with goals that are important to them[7]. Goal setting provides a benchmark that allows people to assess whether or not the intervention is creating value[6]. From an organizational perspective, the degree to which goals are clearly communicated, acted upon, and staff knowing what is measured, monitored, and reported is important to for successful implementation[3]. Less aggressive incremental goals[6] and goals that are specific and attainable[1] will increase implementation effectiveness. Leadership commitment, involvement, and accountability are key features for successful implementation (see Leadership Engagement). Among the most effective ways to engage that support is to have a change effort that is aligned with and contributes to achieving the organizational goals of leadership[3]. Support from leaders is more likely if they are kept involved in and informed about the implementation[8]. A sense of collective responsibility is thought to contribute to implementation success along with a communal understanding of mission and goals and the sense that task decisions are made based on them[2]. The Chronic Care Model emphasizes the importance of relying on multiple methods of evaluation and feedback including clinical, performance, economic evaluations, and experience[9][10].

Measurement

Qualitative codebook guidelines

Inclusion criteria

Include statements related to the (lack of) alignment of the innovation with larger organizational goals, as well as feedback to staff regarding those goals, e.g., regular audit and feedback regarding the gap between the current organizational status and the future (goal) organizational status. Goals and Feedback is independent of the implementation process; it likely continues when implementation activities end.

  • “We really struggled for the first 6 months before the reports finally became available. Once people could see the charts and graphs and see the improvement, then they really internalized it and now it’s being done much more consistently.”
  • “We monitor compliance with a checklist.”
  • “I show them data but I also try to make it real for them. I say, ‘What if your mom or dad were in that bed? Would you raise the head of the bed when they are on a ventilator?’”
  • “I don’t have time to get the data together…I give reports to my boss but I don’t think he ever looks at them.”
  • “Our Director looks at measures about progress of this implementation in her morning report. My boss is in there with her every morning, having to explain any problems we might have.”



Exclusion criteria

Exclude statements that refer to the process used in implementation, i.e., the implementation team’s (lack of) on-going review of implementation progress and code to Reflecting & Evaluating. Reflecting and Evaluating is part of the implementation process; it likely ends when implementation activities end.



Quantitative measures

Attachments

References

  1. 1.0 1.1 1.2 Kochevar LK, Yano EM: Understanding health care organization needs and context. Beyond performance gaps. J Gen Intern Med 2006, 21(Suppl 2):S25-29.
  2. 2.0 2.1 2.2 Simpson DD, Dansereau DF: Assessing Organizational Functioning as a Step Toward Innovation. NIDA Science & Practice Perspectives 2007, 3:20-28.
  3. 3.0 3.1 3.2 3.3 VanDeusen Lukas CV, Holmes SK, Cohen AB, Restuccia J, Cramer IE, Shwartz M, Charns MP: Transformational change in health care systems: An organizational model. Health Care Manage Rev 2007, 32:309-320.
  4. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A: Improving chronic illness care: translating evidence into action. Health Aff (Millwood) 2001, 20:64-78.
  5. 5.0 5.1 Theory at a Glance: A guide for health promotion practice (PDF)
  6. 6.0 6.1 6.2 6.3 Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD: Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback. Qual Saf Health Care 2006, 15:433-436.
  7. 7.0 7.1 Hysong SJ, Best RG, Pugh JA: Audit and feedback and clinical practice guideline adherence: Making feedback actionable. Implement Sci 2006, 1:9.
  8. Meyer AD, Goes JB: Organisational Assimilation of Innovations: A Multi-Level Contextual Analysis. Acad Manage J 1988, 31:897-923.
  9. Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA 2002, 288:1909-1914.
  10. Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness. JAMA 2002, 288:1775-1779.
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