Table 3.

Summary of findings

Acceptability of the programme design
Strengths	Weaknesses	Critical success features
General perceptions
Focus on the core-business of physiotherapists. Uncovers ‘what happens behind closed doors’.	Limited validity client records and videotapes because they are self-selected. Limited validity of online scores due to unwillingness or incompetence to adequately apply performance indicators.	Training in critical performance appraisal to support self-directed quality improvement. Time to build a safe setting allowing to make mistakes. Face-to-face discussions of discrepancies in online scores to compare self-perceptions with peer perceptions and to discuss quality standards of clinical performance. Active participation. Compliance to the programme guidelines. Safe setting.
Assessment of client communication
Shows what physiotherapists ‘do’ instead of what they ‘say they do’. Uncovers undesired attitudes. Allows for modelling desired behaviour.	Reluctance to expose clinical performance to an ‘audience’. Snapshot, poorly representing the process of patient management.	Using worked samples of video-assessment to enhance its acceptability. Extended engagement with video-assessment.
Assessment of record keeping
Presents the process of patient management allowing to assess clinical reasoning and evidence-based practice.
Assessment of management and organisation
Provides guidance to self-direct improvement.

Appropriateness of the implementation strategy
Barriers	Facilitators	Critical success features
Programme aims, expected efforts and desired outcomes insufficiently clarified at baseline. Dominant role of insurers in quality control causing doubts about the stakeholders in the quality improvement programme. Poor programme efficacy beliefs.	Learning by ‘doing’ or by watching others doing it (role models). Emphasis on learning and improvement instead of judgement.	Discussion of programme aims, desired results and consequences on the long term to clarify and align expectations. Shared responsibility for group learning and quality improvement programme outcomes.
Absence of financial incentives.	Awarding efforts with credits.
Complex website design.	Peer coaching in using communication technology.	User friendly website design.
Limited skills of group coaches to enhance shared responsibility for group learning and results.		Competent group coaches.

Impact on quality improvement and professional behaviour change
Individual level	Organisational level	Network level
Awareness of clinical performance.	Awareness of organisational performance.	Increased self-efficacy beliefs and motivation for ongoing PA activities.
New insights in the application of clinical practice guidelines, the use of client reported outcomes and performance measures.	Increased self-efficacy and programme-efficacy beliefs.	Commitment to ongoing PA activities and clinical audits.
Improved client involvement in goal setting and treatment planning.
Improved peer assessment skills.

PA, peer assessment.