Audit and feedback and clinical practice guideline adherence: Making feedback actionable

BACKGROUND: As a strategy for improving clinical practice guideline (CPG) adherence, audit and feedback (A&F) has been found to be variably effective, yet A&F research has not investigated the impact of feedback characteristics on its effectiveness. This paper explores how high performing facilities (HPF) and low performing facilities (LPF) differ in the way they use clinical audit data for feedback purposes. METHOD: Descriptive, qualitative, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low adherence to six CPGs, as measured by external chart review audits. One-hundred and two employees involved with outpatient CPG implementation across the six facilities participated in one-hour semi-structured interviews where they discussed strategies, facilitators and barriers to implementing CPGs. Interviews were analyzed using techniques from the grounded theory method. RESULTS: High performers provided timely, individualized, non-punitive feedback to providers, whereas low performers were more variable in their timeliness and non-punitiveness and relied on more standardized, facility-level reports. The concept of actionable feedback emerged as the core category from the data, around which timeliness, individualization, non-punitiveness, and customizability can be hierarchically ordered. CONCLUSION: Facilities with a successful record of guideline adherence tend to deliver more timely, individualized and non-punitive feedback to providers about their adherence than facilities with a poor record of guideline adherence. Consistent with findings from organizational research, feedback intervention characteristics may influence the feedback's effectiveness at changing desired behaviors

Negotiating peace: the role of procedural and distributive justice in achieving durable peace

Many civil wars have been terminated with a peace agreement that ends the fighting, but these agreements have not always resulted in lasting peace. Earlier research on peace agreements has missed important points during which justice principles can play a role in establishing durable peace – during the negotiation process itself (procedural justice: PJ) and as incorporated into the negotiated outcome (distributive justice: DJ). Nor has the earlier research con-sidered the variety of dimensions that define durable peace, including recon-ciliation, governance and security institution building and economic growth. This study fills these gaps by examining the relationship between the justice and peace variables in 50 civil wars. Our analyses show that PJ and DJ led to more stable agreements and to a more durable peace: A significant time-lagged path from the justice to peace variables was demonstrated. The results suggest that just negotiation processes and outcomes are important contributors to peace