{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T01:54:28Z","timestamp":1768442068080,"version":"3.49.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T00:00:00Z","timestamp":1674518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"St. Michael\u2019s Hospital AFP Innovation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Explore characteristics of the facilitator, group, and interaction that influence whether a group discussion about data leads to the identification of a clearly specified action plan. Peer-facilitated group discussions among primary care physicians were carried out and recorded. A follow-up focus group was conducted with peer facilitators to explore which aspects of the discussion promoted action planning. Qualitative data was analyzed using an inductive-deductive thematic analysis approach using the conceptual model developed by Cooke et al. Group discussions were coded case-specifically and then analyzed to identify which themes influenced action planning as it relates to performance improvement. Physicians were more likely to interact with practice-level data and explore actions for performance improvement when the group facilitator focused the discussion on action planning. Only one of the three sites (Site C) converged on an action plan following the peer-facilitated group discussion. At Site A, physicians shared skepticism of the data, were defensive about performance, and explained performance as a product of factors beyond their control. Site B identified several potential actions but had trouble focusing on a single indicator or deciding between physician- and group-level actions. None of the groups discussed variation in physician-level performance indicators, or how physician actions might contribute to the reported outcomes. Peer facilitators can support data interpretation and practice change; however their success depends on their personal beliefs about the data and their ability to identify and leverage change cues that arise in conversation. Further research is needed to understand how to create a psychologically safe environment that welcomes open discussion of physician variation.<\/jats:p>","DOI":"10.1093\/tbm\/ibac114","type":"journal-article","created":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T05:35:05Z","timestamp":1674624905000},"page":"316-326","source":"Crossref","is-referenced-by-count":6,"title":["Snakes and ladders: A qualitative study understanding the active ingredients of social interaction around the use of audit and feedback"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3429-1865","authenticated-orcid":false,"given":"Laura","family":"Desveaux","sequence":"first","affiliation":[{"name":"Institute for Better Health, Trillium Health Partners , 100 Queensway West, Mississauga, Ontario , Canada"},{"name":"Women\u2019s College Hospital Institute for Health Systems Solutions and Virtual Care , 76 Grenville Ave Toronto, Toronto, Ontario , Canada"},{"name":"Institute for Health Policy, Management & Evaluation, University of Toronto , 155 College St, Toronto, Ontario , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marlena Dang","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Women\u2019s College Hospital Institute for Health Systems Solutions and Virtual Care , 76 Grenville Ave Toronto, Toronto, Ontario , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noah Michael","family":"Ivers","sequence":"additional","affiliation":[{"name":"Women\u2019s College Hospital Institute for Health Systems Solutions and Virtual Care , 76 Grenville Ave Toronto, Toronto, Ontario , Canada"},{"name":"Department of Family and Community Medicine, University of Toronto , 500 University Avenue, Toronto , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Devotta","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael\u2019s Hospital , 30 Bond Street, Toronto , Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto , 155 College St, Toronto , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tara","family":"Upshaw","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael\u2019s Hospital , 30 Bond Street, Toronto , Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto , 155 College St, Toronto , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noor","family":"Ramji","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Toronto , 500 University Avenue, Toronto , Canada"},{"name":"Department of Family and Community Medicine, St. Michael\u2019s Hospital , 30 Bond Street , Toronto , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Weyman","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Toronto , 500 University Avenue, Toronto , Canada"},{"name":"Department of Family and Community Medicine, St. Michael\u2019s Hospital , 30 Bond Street , Toronto , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tara","family":"Kiran","sequence":"additional","affiliation":[{"name":"Institute for Health Policy, Management & Evaluation, University of Toronto , 155 College St, Toronto, Ontario , Canada"},{"name":"Department of Family and Community Medicine, University of Toronto , 500 University Avenue, Toronto , Canada"},{"name":"MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael\u2019s Hospital , 30 Bond Street, Toronto , Canada"},{"name":"Department of Family and Community Medicine, St. Michael\u2019s Hospital , 30 Bond Street , Toronto , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,1,24]]},"reference":[{"issue":"9","key":"2023051308192383300_CIT0001","first-page":"442","article-title":"Critically appraised topics and evidence-based medicine journals.","volume":"46","author":"Dawes","year":"2005","journal-title":"Singapore Med J."},{"issue":"4","key":"2023051308192383300_CIT0002","first-page":"271","article-title":"How GPs learn.","volume":"20","author":"MacLeod","year":"2009","journal-title":"Educ Prim Care."},{"issue":"3","key":"2023051308192383300_CIT0003","first-page":"258","article-title":"\u201cMy approach to this job is... 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