Table 1 Primer on Clinical Performance Feedback Intervention Theory (CP-FIT)

CP-FIT is synthesised from 65 qualitative studies of 73 A&F interventions and 30 pre-existing theories and describes causal pathways of feedback [20]. It states that effective feedback is a cyclical process of goal setting, data collection and analysis, feedback, recipient interaction, perception, and acceptance of the feedback, followed by intention, behaviour, and clinical performance improvement (the feedback cycle) (Fig. 1) [20]. Feedback becomes less effective if any individual process fails causing progress round the feedback cycle to stop and is influenced by variables relating to the feedback itself (its goal, data collection and analysis methods, feedback display, and feedback delivery), the recipient (health professional characteristics and behavioural response), and context (organisation or team characteristics, patient population, co-interventions, and implementation process) (Fig. 1) [20]. These variables exert their effects via explanatory mechanisms of complexity, relative advantage, resource match, compatibility, credibility, social influence, and actionability and are summarised by three propositions [20]:

 (a) Capacity limitations: Healthcare professionals and organisations have a finite capacity to engage with and respond to feedback; interventions that require less work, supply, additional resource, or are considered worthwhile enough to justify investment are most effective.

 (b) Identity and culture: Healthcare professionals and organisations have strong beliefs regarding how patient care should be provided that influence their interactions with feedback; those that align with and enhance these aspects are most effective.

 (c) Behavioural induction: Feedback interventions that successfully and directly support clinical behaviours for individual patients are most effective.