Table 4 Determinants of learning and change objectives and the associated strategies

Knowledge

Familiarity with the content of the guideline

Dissemination of training material

Active learning from experts

Making guideline available in combination with practical instruments

Skills

The ability to apply knowledge in practice

Interactive group training

Interactive training in use of the guidelines

Attitude

Willingness to accept the guidelines and use them to improve quality

Persuasion by opinion leaders

Benefits highlighted during training and by staff and the Netherlands Association for Insurance Medicine

Self-efficacy

Belief in ability to use the guidelines in practice and finding answers to questions

Performance-related feedback

Positive individualised feedback during training and subsequently in practice, assistance with questions

Expectations

Expectation that the guideline will contribute to more evidence-based assessments

Individualized feedback and group performance audit data

Training in use of the guidelines with exercise case-histories, feedback at group and individual level

Change objectives for the environment

Availability

The ability to practise, ask questions and work on personal performance

Feedback, personal improvement, planning

Practice in training, feedback on performance, support with questions

Uniformity

All insurance physicians covered by similar requirements

Quality-monitoring and quality-management

Staff physician appraises all insurance physicians using the same indicators

Support

Support from colleagues, staff, management and professional association, facilitation and, where necessary, amendment of the work process

In-built process reminders, quality management, support from opinion leaders

Quality evaluation by management, staff quality-oriented direction, promotion by the Netherlands Association for Insurance Medicine