Measuring the perceived impact of facilitation on implementing recommendations from external assessment: lessons from the Dutch visitatie programme for medical specialists
Article first published online: 22 JUL 2005
Journal of Evaluation in Clinical Practice
Volume 11, Issue 6, pages 587–597, December 2005
How to Cite
Lombarts, M. J. M. H., Klazinga, N. S. and Redekop, K. (2005), Measuring the perceived impact of facilitation on implementing recommendations from external assessment: lessons from the Dutch visitatie programme for medical specialists. Journal of Evaluation in Clinical Practice, 11: 587–597. doi: 10.1111/j.1365-2753.2005.00595.x
- Issue published online: 30 NOV 2005
- Article first published online: 22 JUL 2005
- Accepted for publication: 8 December 2004
- external assessment;
- medical specialists;
- peer review;
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 ∼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.