Understanding and using quality information for quality improvement: The effect of information presentation.

Objective: To examine how information presentation affects the understanding and use of information for quality improvement.

Design: An experimental design, testing 22 formats, and showing information on patient safety culture. Formats differed in visualization, outcomes and benchmark information.

Intervention(s): Respondents viewed three randomly selected presentation formats in an online survey, completing several tasks per format.

Setting: The hospital sector in the Netherlands.

Participants: A volunteer sample of healthcare professionals, mainly nurses, working in hospitals. Main Outcome Measure(s): The degree to which information is understandable and usable (accurate choice for quality improvement, sense of urgency to change and appraisal of one's own performance).

Results: About 115 healthcare professionals participated (response rate 25%), resulting in 345 reviews.

Understandability: Information in tables (P = 0.007) and bar charts (P < 0.0001) was better understood than radars. Presenting outcomes on a 5-point scale (P < 0.001) or as '% positive responders' (P < 0.001) was better understood than '% negative responders'. Formats without benchmarks were better understood than formats with benchmarks. Use: Bar charts resulted in more accurate choices than tables (P = 0.003) and radars (P < 0.001). Outcomes on a 5-point scale resulted in more accurate choices than '% negative responders' (P = 0.007). Presenting '% positive responders' resulted in a higher sense of urgency to change than outcomes on a 5-point scale (P = 0.002). Benchmark information had inconsistent effects on the appraisal of one's own performances.

Conclusions: Information presentation affects healthcare professionals' understanding and use of quality information. Our findings supplement the further understanding on how quality information can be best communicated to healthcare professionals for realizing quality improvements.