• external assessment;
  • facilitation;
  • implementation;
  • medical specialists;
  • peer review;
  • visitatie


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.