Creating a culture of quality: our experience with providing feedback to frontline hospitalists

BACKGROUND: One way to provide performance feedback to hospitalists is through the use of dashboards, which deliver data based on agreed-upon standards. Despite the growing trend on feedback performance on quality metrics, there remain limited data on the means, frequency and content of feedback that should be provided to frontline hospitalists. OBJECTIVE: The objective of our research is to report our experience with a comprehensive feedback system for frontline hospitalists, as well as report the change in our quality metrics after implementation. DESIGN, SETTING AND PARTICIPANTS: This quality improvement project was conducted at a tertiary academic medical centre among our hospitalist group consisting of 46 full-time faculty members. INTERVENTION OR EXPOSURE: A monthly performance feedback report was distributed to provide ongoing feedback to our hospitalist faculty, including an individual dashboard and a peer comparison report, complemented by coaching to incorporate process improvement tactics into providers’ daily workflow. MAIN OUTCOMES AND MEASURES: The main outcome of our study is the change in quality metrics after implementation of the monthly performance feedback report RESULTS: The dashboard and rank order list were sent to all faculty members every month. An improvement was seen in the following quality metrics: length of stay index, 30-day readmission rate, catheter-associated urinary tract infections, central line-associated bloodstream infections, provider component of Healthcare Consumer Assessment of Healthcare Providers and Systems scores, attendance at care coordination rounds and percentage of discharge orders placed by 10:00. CONCLUSIONS: Implementation of a monthly performance feedback report for hospitalists, complemented by peer comparison and guidance on tactics to achieve these metrics, created a culture of quality and improvement in the quality of care delivered.