The engagement equation: A model for understanding what drives physician engagement with data-driven clinical performance feedback

Background: Clinical performance feedback (CPF) is widely used to support physician development and improve care. Yet, its impact remains limited by low voluntary engagement. This study sought to: (1) develop a theory-informed model outlining the key beliefs that shape physician engagement with CPF; (2) explore patterns of feedback orientation across physicians; and (3) understand how individual perceptions influence engagement with CPF. Methods: We used a cross-sectional, multi-method approach combining a survey and qualitative interviews with primary care physicians in Ontario, Canada. We validated a conceptual model using path analysis, explored heterogeneity in feedback orientation using latent profile analysis, and qualitatively examined how perceptions of CPF influenced engagement. Results: Survey results (n=206) supported a model in which engagement with CPF is shaped by five recipient characteristics: perceived need for change (change discrepancy), perceived value of CPF, confidence to act on feedback (feedback self-efficacy), belief that feedback is useful (feedback utility), and sense of responsibility to act (feedback accountability). Perceived utility mediated the effects of self-efficacy and value on accountability, and perceived need for change influenced value. Latent profile analysis identified three groups: physicians with high and balanced feedback orientation (n=32), moderate and balanced (n=143), and low feedback orientation with low self-efficacy (n=31). Interview findings (n=9) revealed two mindsets: physicians who saw value in CPF despite its limitations (engagers), and those who dismissed its relevance (non-engagers). These mindsets aligned with differences in value, utility, and accountability scores from the survey. Conclusions: Engagement with CPF is not one-size-fits-all. Physicians differ in how they appraise and act on feedback based on their beliefs about its relevance, usefulness, and their ability to act. CPF initiatives should explicitly link feedback to improved patient outcomes, focus on future actions, and provide clear, actionable guidance. Designing CPF that accounts for recipient heterogeneity is essential to realizing its full potential as an improvement strategy.