Table 4

Intervention functions, policies and definitions with examples of participant-identified interventions (based on Michie et al)

Intervention functionDefinitionExamples of identified interventions
EducationIncrease knowledge or understandingOffer QI and clinical laboratory educational sessions (clinical best practice); and
Apply guidelines (laboratory test ordering protocols)
PersuasionCommunication is used to elicit positive or negative emotions, or to stimulate actionCommunication from a credible physician leader to encourage behavioural test ordering change and QI project participation
IncentivisationCreate expectation of rewardProvide financial reimbursement for physician-led QI
Coercion/ consequenceCreate expectation of negative consequence, punishment or costProvide cost data to demonstrate negative consequence
TrainingImpart skillsProvide hands-on experiential QI opportunity to apply knowledge and leadership
RestrictionUsing 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 restructuringChanging the physical or social contextUpdate paper and IT lab test order forms, to prevent reflexive ordering
ModellingProviding an example for people to aspire to or imitateProvide examples of past physician-led projects targeting lab test reduction
Provide physician QI mentors
EnablementIncreasing means/reducing barriers to increase capability or opportunityProvide support personnel-QI consultant and data analysts
Provide frequent audit reports—lab test utilisation data to enable practice change
Communication/ marketingUsing print, electronic, telephone or broadcast mediaDisplay posters on the hospital units
Decision support tools, provided at points of physician ordering to encourage appropriate testing
GuidelinesCreating documents that recommend or mandate practice. This includes all changes to service provisionDevelop and disseminate laboratory test ordering guidelines.
FiscalUsing the health organisation budgeting processes to reduce or increase the financial costReport and disseminate organisational budgetary impacts related lab test ordering
RegulationEstablishing rules or principles of behaviour or practiceImplement or adapt as required organisational wide Choosing Wisely recommendations
LegislationMaking or changing lawsProhibit diagnostic testing resource waste, monitored and reported by health organisation
Environmental/social planningDesigning and/or controlling the physical or social environmentEngage 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 provisionDelivering a serviceEstablish formal physician QI leadership role and job description (QI activities have priority)
  • QI, quality improvement.