JMIR Publications

ABSTRACT

Background:

Audit and Feedback (A&F), the summary and provision of clinical performance data, is a common quality improvement strategy. Successful design and implementation of A&F – or any quality improvement strategy - should incorporate evidence-informed best practices as well as context-specific, end-user input.

Objective:

We used audit and feedback theory and user-centered design to inform the development of an interactive web-based primary care audit and feedback dashboard. We describe the design process and how it influenced the design of the dashboard.

Methods:

Our design process included three phases: prototype development based on A&F theory and input from clinical improvement leaders; workshop with family physician quality improvement leaders to develop personas (i.e., fictional users that represent an archetype character representative of our key users) and application of those personas to design decisions; and user-centered interviews with family physicians to learn about the physician’s reactions to the revised dashboard.

Results:

The team applied audit and feedback best practices to the dashboard prototype. Personas were used to identify target groups with challenges and behaviours as a tool for informed design decision making. Our workshop produced three user personas: Dr. Skeptic, Frazzled Physician, and Eager Implementer representing common users based on the team’s experience of audit and feedback. Interviews were conducted to further validate findings from the persona workshop and found that: (1) physicians were interested in how they compare with peers; however if performance was above average, they were not motivated to improve even if gaps compared to other standards in their care remained; (2) burnout levels were high as physicians are trying to catch up on missed care during the pandemic and are therefore less motivated to act on the data; and (3) additional desired features included integration within the EMR, and more up-to-date and accurate data.

Conclusions:

We found that carefully incorporating data from user interviews helped operationalize generic best practices for audit and feedback to achieve an acceptable dashboard that could meet the needs and goals of physicians. We demonstrate in this paper such a design process. A&F dashboards should address physicians’ data skepticism, present data in a way that spurs action, and support physicians to have time and capacity to engage in quality improvement work; the steps we followed may help those responsible for quality improvement strategy implementation achieve these aims. Clinical Trial: N/A