Table 1 Perception of the MSF process

Perceptions of appropriateness, and purpose of the MSF process: PPs indicated they understood and recognized the relevance of the project for the physician population. The prospect for performance feedback was seen as an opportunity for their own personal improvement but PPs were skeptical of the improvement of others.

I’m a big supporter of these projects. I think if we don’t assess ourselves we will not know about our performance. That’s one way of assessing ourselves and maybe in the future we’ll find out that we need to tweak it a little bit. PP2

I think that these questionnaires, these sorts of interrogation tools are very useful for gathering information. It really is dependent upon other people as to how much you effect changes. If you received information through a questionnaire such as this that suggests that somebody is under-performing, that gets you information about that performance, but not necessarily ensures that something will be then done … We hear the fire alarm go off every day. It doesn’t necessarily mean that we are going to have less fires; it just means that you can hear the fire alarm. PP1

Culture change: The need to build the PQII into a more global strategy for quality improvement and culture change.

I think the whole shift has to be really about creating a culture where people actually care what the answers are. A lot of what we’ve talked about today is about the mechanics of asking people a question and the mechanics of giving them the answer. What you have to do first and foremost is make people care about what the answer is. If people care about what the answer is they’ll find out the information in a variety of ways. DC2

Barriers to completing the MSF process: Physicians had varied success collecting reviewer feedback. Other limitations discussed by participants included finding the time to sign in to the online program and select reviewers, the response rate of physician colleague and coworker reviewers and manually adding contact information of reviewers who worked outside of the organization.

I don’t work with eight doctors. I know eight doctors. I had to scramble. I only work with about three or four people in an intimate way, that constant interaction, constant work. PP7

Receiving Feedback : Participants were engaged and invested in receiving their feedback. PPs and DCs indicated that the feedback affirmed that overall the participants were doing a good job, with few exceptions. PPs found the process reassuring, useful and an opportunity for self-reflection and to contemplate possible improvements.

I have a pretty good idea of how I practice already and I know I’m… what it did is it actually reinforced that I’m a pretty good read of my own strengths and my own weaknesses based on… in that sense, it was a useful exercise…… I think it can be very enlightening. It’s reassuring to know that at the end, what I think of my practice is what other people think of my practice. That was comforting. PP9

I remember… it’s nice to have the averages and see where you sit within the cohort, like if you’re the middle or above. I found that actually quite useful. PP9

It reinforces that you actually are doing a reasonable job. That’s an important thing, because it can reaffirm that. PP6

“That’s an area to improve. How do I improve it?” Now I would have to go to my patients and say, “How can I improve?” Maybe that’s what I should do. Maybe that’s up to me. PP8