The impact of patient feedback on the medical performance of qualified doctors: a systematic review

Background: Patient feedback is considered integral to quality improvement and professional development.However, while popular across the educational continuum, evidence to support its efficacy in facilitatingpositive behaviour change in a postgraduate setting remains unclear. This review therefore aims to explore the evidence that supports or refultes the impact of patient feedback on the medical performance of qualified doctors. Methods: Electronic databases PubMed, EMBASE, Medlineand PsycINFO were systematically searched forstudies assessing the impact of patient feedback on medical performance published in the Englishlanguage between 2006-2016. Impact was defined as a measured change in behaviour using Barr’s (2000)adaptation of Kirkpatrick’s four level evaluation model. Papers werequality appraised, thematically analysedand synthesised using a narrative approach. Results: From 1,269 initial studies, 20 articles were included (qualitative (n=8); observational (n=6); systematic review(n=3); mixed methodology (n=1); randomised control trial (n=1); and longitudinal (n=1) design). One article identifiedchange at an organisational level (Kirkpatrick level 4); six reported a measured change in behaviour (Kirkpatrick level3b); 12 identified self-reported change or intention to change (Kirkpatrick level 3a), and one identified knowledge orskill acquisition (Kirkpatrick level 2). No study identified a change at the highest level, an improvement in the healthand wellbeing of patients. The main factors found to influence the impact of patient feedback were: specificity;perceived credibility; congruence with physician self-perceptions and performance expectations; presence of facilitation and reflection; and inclusion of narrativecomments. The quality of feedback facilitation and localprofessional cultures also appeared integral to positive behaviour change. Conclusion: Patientfeedbackcanhaveanimpactonmedicalperformance. However, actionable change is influencedby several contextual factors and cannot simply be guaranteed. Patient feedback is likely to be more influential if it isspecific, collected through credible methods and containsnarrative information. Data obtained should be fed back in away that facilitates reflective discussion and encourages the formulation of actionable behaviour change. A supportivecultural understanding of patient feedback and its intended purpose is also essential for its effective use.