Audit and Feedback to Reduce Clinical Variation

This research article examines the implementation of audit and feedback strategies aimed at reducing unwarranted clinical variation in hospital care. The study focuses on a state-wide value-based healthcare program in New South Wales, Australia, implemented from 2017 to 2021. It identifies the mechanisms and contextual factors that influence the effectiveness of audit and feedback in modifying clinical practices. The research utilizes multiple data sources, including systematic reviews and semi-structured interviews with 56 participants, to develop an initial program theory. The findings reveal eight mechanisms through which the audit and feedback strategy operates, emphasizing the importance of clinician engagement, clarity of information, and accountability. The study concludes that successful implementation requires meaningful audit indicators, involvement of clinical staff, and respect for clinical expertise. Additionally, it proposes a Model for Audit and Feedback Implementation at Scale, contributing to the theoretical understanding of audit and feedback processes in healthcare systems.