How do hospitals respond to feedback about blood transfusion practice? A multiple case study investigation

National clinical audits play key roles in improving care and driving system-wide change. However, effects of audit and feedback depend upon both reach (e.g. relevant staff receiving the feedback) and response (e.g. staff regulating their behaviour accordingly). This study aimed to investigate which hospital staff initially receive feedback and formulate a response, how feedback is disseminated within hospitals, and how responses are enacted (including barriers and enablers to enactment). Using a multiple case study approach, we purposively sampled four UK hospitals for variation in infrastructure and resources. We conducted semi-structured interviews with staff from transfusion-related roles and observed Hospital Transfusion Committee meetings. Interviews and analysis were based on the Theoretical Domains Framework of behaviour change. We coded interview transcripts into theoretical domains, then inductively identified themes within each domain to identify barriers and enablers. We also analysed data to identify which staff currently receive feedback and how dissemination is managed within the hospital. Members of the hospital’s transfusion team initially received feedback in all cases, and were primarily responsible for disseminating and responding, facilitated through the Hospital Transfusion Committee. At each hospital, key individuals involved in prescribing transfusions reported never having received feedback from a national audit. Whether audits were discussed and actions explicitly agreed in Committee meetings varied between hospitals. Key enablers of action across all cases included clear lines of responsibility and strategies to remind staff about recommendations. Barriers included difficulties disseminating to relevant staff and needing to amend feedback to make it appropriate for local use. Appropriate responses by hospital staff to feedback about blood transfusion practice depend upon supportive infrastructures and role clarity. Hospitals could benefit from support to disseminate feedback systematically, particularly to frontline staff involved in the behaviours being audited, and practical tools to support strategic decision-making (e.g. action-planning around local response to feedback).国家临床审计（National clinical audits）在提升医疗服务质量、推动全系统变革方面发挥着关键作用。然而，审计与反馈的实施效果同时取决于覆盖范围（即相关医护人员接收反馈的情况）与响应程度（即医护人员据此规范自身行为的情况）。本研究旨在探究哪些医院医护人员会率先接收反馈并制定响应方案、反馈在医院内部的传播路径，以及响应方案的落地实施情况（含实施过程中的阻碍因素与促进因素）。本研究采用多案例研究方法，基于基础设施与资源的差异，目的性抽样选取了4家英国医院作为研究对象。我们对输血相关岗位的医护人员开展半结构化访谈，并观摩了医院输血委员会（Hospital Transfusion Committee）的会议。本研究的访谈与分析均基于行为改变理论域框架（Theoretical Domains Framework of behaviour change）：研究人员将访谈转录文本编码至各理论域中，随后通过归纳法在每个理论域内提炼主题，以识别阻碍因素与促进因素。此外，我们还通过数据分析明确了当前接收反馈的医护人员名单，以及医院内部的反馈传播管理方式。所有案例中，医院输血团队成员均率先接收反馈，且主要负责通过医院输血委员会推进反馈的传播与响应落地。但各医院中，参与输血处方工作的核心人员均表示，从未接收过来自国家临床审计的反馈。不同医院的输血委员会会议中，是否会讨论审计结果并明确商定后续行动的情况存在差异。所有案例中共同的行动促进因素包括清晰的职责划分，以及用于提醒医护人员关注审计建议的配套策略。而行动阻碍因素则包括向相关医护人员传播反馈时存在难度，以及需对反馈内容进行调整以适配本地使用场景。医院医护人员针对输血实践反馈采取的恰当响应，依赖于完善的支撑性基础设施与清晰的岗位职责划分。医院可通过系统化传播反馈的支持方案（尤其是向参与被审计行为的一线医护人员传播），以及用于辅助战略决策的实用工具（如围绕本地反馈响应制定行动计划）来提升工作成效。