Intervention functions, policies and definitions with examples of participant-identified interventions (based on Michie et al)
| Intervention function | Definition | Examples of identified interventions |
| Education | Increase knowledge or understanding | Offer QI and clinical laboratory educational sessions (clinical best practice); and Apply guidelines (laboratory test ordering protocols) |
| Persuasion | Communication is used to elicit positive or negative emotions, or to stimulate action | Communication from a credible physician leader to encourage behavioural test ordering change and QI project participation |
| Incentivisation | Create expectation of reward | Provide financial reimbursement for physician-led QI |
| Coercion/ consequence | Create expectation of negative consequence, punishment or cost | Provide cost data to demonstrate negative consequence |
| Training | Impart skills | Provide hands-on experiential QI opportunity to apply knowledge and leadership |
| Restriction | Using rules to reduce the opportunity to engage in the target behaviour (or to increase the target behaviour by reducing the opportunity to engage in competing behaviours) | Limit lab test order frequency when results are normal—ie, once per week, etc. |
| Environmental restructuring | Changing the physical or social context | Update paper and IT lab test order forms, to prevent reflexive ordering |
| Modelling | Providing an example for people to aspire to or imitate | Provide examples of past physician-led projects targeting lab test reduction Provide physician QI mentors |
| Enablement | Increasing means/reducing barriers to increase capability or opportunity | Provide support personnel-QI consultant and data analysts Provide frequent audit reports—lab test utilisation data to enable practice change |
| Policies | ||
| Communication/ marketing | Using print, electronic, telephone or broadcast media | Display posters on the hospital units Decision support tools, provided at points of physician ordering to encourage appropriate testing |
| Guidelines | Creating documents that recommend or mandate practice. This includes all changes to service provision | Develop and disseminate laboratory test ordering guidelines. |
| Fiscal | Using the health organisation budgeting processes to reduce or increase the financial cost | Report and disseminate organisational budgetary impacts related lab test ordering |
| Regulation | Establishing rules or principles of behaviour or practice | Implement or adapt as required organisational wide Choosing Wisely recommendations |
| Legislation | Making or changing laws | Prohibit diagnostic testing resource waste, monitored and reported by health organisation |
| Environmental/social planning | Designing and/or controlling the physical or social environment | Engage laboratory medicine and physician professional association leaders in strategic planning regarding lab ordering Engage health organisations human resources dept. regarding formalisation of physician-QI leadership role (job description) |
| Service provision | Delivering a service | Establish formal physician QI leadership role and job description (QI activities have priority) |
QI, quality improvement.