Supporting Dutch medical specialists with the implementation of visitatie recommendations: a descriptive evaluation of a 2-year project.

OBJECTIVE To improve the quality of patient care by supporting the implementation of practice-specific visitatie (external peer review) recommendations. DESIGN A descriptive evaluation of an intervention strategy (Quality Consultation). Data collection through participatory observation, telephone interviews, and a postal survey. SETTING Twenty-five specialist group practices (67 specialists) from the specialty societies of surgeons, paediatricians, and gynaecologists, supported in their implementation efforts by two experienced management consultants. INTERVENTION Approximately 20 h of management consultancy. The Quality Consultation took a site-specific multifaceted implementation approach; its tool kit consisted of various management and quality improvement support methods. MAIN MEASURES Choice of recommendations supported; type of interventions offered; degree of implementation; appreciation of implementation results and process; and impact of management consultants as assessed by participants. RESULTS The level of participation was high and evaluation of the consultants and the impact of their support positive. Most implementation projects were related to strategic issues or the functioning of the specialist group. Every specialist group was offered multiple interventions, both participatory and non-participatory. The degree of implementation was rated 4.0 on a 5-point scale; the scores for the implementation result and process were 6.6 on a 10-point scale. CONCLUSIONS Visitatie seems to inherently enforce the development of management of medical specialist care. This might also be true for other external peer review models. The development of effective specialist groups deserves high priority in order to implement visitatie recommendations successfully. Management consultants can be instrumental in this process.