Creation and validation of the PERFECT: a critical incident tool for evaluating change in the practices of health professionals

Rationale The critical incident technique provides a means to better understand the reasons behind clinicians' practices and changes in practice. No standardized tool exists to elicit information using this technique. Objectives To create and validate a standardized tool that explores change and reasons for change in professional practice. Method Item generation was based on expert consultation and a review of the clinical practice and knowledge translation literature. The draft tool was pilot-tested with a convenience sample of 10 rehabilitation clinicians to receive feedback on its content, clarity, optimal cueing, omissions and ease of recall of critical incidents. Results The tool was progressively refined and validated according to feedback from both the clinicians and expert reviewers. The final version of the tool includes 33 questions designed to elicit information on change and reasons for change in four areas: problem identification, assessment, treatment and referral practices. In addition, it elicits information on factors that facilitate or hinder change in practice. Cues are included when necessary to clarify questions and facilitate responses. Regarding ease of recall, all clinicians confirmed that beginning with a 6-month recall of practice change and working back to 1 year was a facilitator. All clinicians mentioned that the tool encouraged them to reflect about changes they made in their practice or lack thereof. Conclusion The newly created standardized critical incident tool, named the PERFECT (Professional Evaluation & Reflection on Change Tool) provides an opportunity for widespread applicability to explore change, reasons for change, as well as facilitators and barriers to change in the practices of health professionals.