Do medical specialists accept claims-based Audit and Feedback for quality improvement? A focus group study.

OBJECTIVES: Audit and Feedback (A&F) is a widely used quality improvement (QI) intervention in healthcare. However, not all feedback is accepted by professionals. While claims-based feedback has been previously used for A&F interventions, its acceptance by medical specialists is largely unknown. This study examined medical specialists' acceptance of claims-based A&F for QI. DESIGN: Qualitative design, with focus group discussions. Transcripts were analysed using discourse analysis. SETTING AND PARTICIPANTS: A total of five online focus group discussions were conducted between April 2021 and September 2022 with 21 medical specialists from varying specialties (urology; paediatric surgery; gynaecology; vascular surgery; orthopaedics and trauma surgery) working in academic or regional hospitals in the Netherlands. RESULTS: Participants described mixed views on using claims-based A&F for QI. Arguments mentioned in favour were (1) A&F stimulates reflective learning and improvement and (2) claims-based A&F is more reliable than other A&F. Arguments in opposition were that (1) A&F is insufficient to create behavioural change; (2) A&F lacks clinically meaningful interpretation; (3) claims data are invalid for feedback on QI; (4) claims-based A&F is unreliable and (5) A&F may be misused by health insurers. Furthermore, participants described several conditions for the implementation of A&F which shape their acceptance. CONCLUSIONS: Using claims-based A&F for QI is, for some clinical topics and under certain conditions, accepted by medical specialists. Acceptance of claims-based A&F can be shaped by how A&F is implemented into clinical practice. When designing A&F for QI, it should be considered whether claims data, as the most resource-efficient data source, can be used or whether it is necessary to collect more specific data.

Catching a glimpse: Corona-life and its micro-politics in academia.

The spread of COVID-19 acutely challenges and affects not just economic markets, demographic statistics and healthcare systems, but indeed also the politics of organizing and becoming in a new everyday life of academia emerging in our homes. Through a collage of stories, snapshots, vignettes, photos and other reflections of everyday life, this collective contribution is catching a glimpse of corona-life and its micro-politics of multiple, often contradicting claims on practices as many of us live, work and care at home. It embodies concerns, dreams, anger, hope, numbness, passion and much more emerging amongst academics from across the world in response to the crisis. As such, this piece manifests a shared need to - together, apart - enact and explore constitutive relations of resistance, care and solidarity in these dis/organizing times of contested spaces, identities and agencies as we are living-working-caring at home during lockdowns.

Citizens as Active Participants in Integrated Care: Challenging the Field's Dominant Paradigms.

Policy makers, practitioners and academics often claim that care users and other citizens should be 'at the center' of care integration pursuits. Nonetheless, the field of integrated care tends to approach these constituents as passive recipients of professional and managerial efforts. This paper critically reflects on this discrepancy, which, we contend, indicates both a key objective and an ongoing challenge of care integration; i.e., the need to reconcile (1) the professional, organizational and institutional frameworks by which care work is structured with (2) the diversity and diffuseness that is inherent to pursuits of active user and citizen participation. By identifying four organizational tensions that result from this challenge, we raise questions about whose knowledge counts (lay/professional), who is in control (local/central), who participates (inclusion/exclusion) and whose interests matter (civic/organizational). By making explicit what so often remains obscured in the literature, we enable actors to more effectively address these tensions in their pursuits of care integration. In turn, we are able to generate a more realistic outlook on the opportunities, limitations and pitfalls of citizen participation.

Empowering citizens or mining resources? The contested domain of citizen engagement in professional care services.

When studying individual attempts to foster citizen engagement, scholars have pointed to the coexistence of competing rationales. Thus far, however, current literature barely elaborates on the socio-political processes through which employees of professional organizations deal with such disparate considerations. To address this gap, this article builds on an ethnographic study, conducted in the Netherlands between 2013 and 2016, of a professional care organization's attempts to engage local citizens in one of its elderly care homes. To investigate how citizen engagement is 'done' in the context of daily organizing, we followed employees as they gradually created and demarcated the scope for such engagement by approaching citizens as either strategic partners (pursuing 'democratic' rationales) or as operational volunteers (pursuing 'instrumental' rationales). In order to deal with such potentially incongruent orientations, we found that employees used discursive strategies to influence the balance that was struck between competing rationales; either through depoliticization-i.e., the downplaying of incongruities and the framing of disparate considerations as being complementary within the pursuit of a shared, overarching goal-or through politicization, i.e., the active challenging of how their colleagues prioritized one consideration over another. By showing how the successful conveyance of such (de)politicized accounts helped employees either defend or redraw the boundaries of what citizen engagement was (not) about, we contribute to extant theorization by (1) developing a processual approach to studying citizen engagement that (2) is sensitive to organizational politics.