Development of a video-observation method for examining doctors' clinical and interpersonal skills in a hospital outpatient clinic in Ibadan, Oyo State, Nigeria

Navneet Aujla, Temitope Ilori, Achiaka Irabor, Abimbola Obimakinde, Eme Owoaje, Olufunke Fayehun, Motunrayo M Ajisola, Sinmisola O Bolaji, Samuel I Watson, Timothy P Hofer, Akinyinka Omigbodun, Richard J Lilford

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BackgroundImproving the quality of primary healthcare provision is a key goal in low-and middle-income countries (LMICs). However, to develop effective quality improvement interventions, we first need to be able to accurately measure the quality of care. The methods most commonly used to measure the technical quality of care all have some key limitations in LMICs settings. Video-observation is appealing but has not yet been used in this context. We examine preliminary feasibility and acceptability of video-observation for assessing physician quality in a hospital outpatients’ department in Nigeria. We also develop measurement procedures and examine measurement characteristics.
MethodsCross-sectional study at a large tertiary care hospital in Ibadan, Nigeria. Consecutive physician-patient consultations with adults and children under five seeking outpatient care were video-recorded. We also conducted brief interviews with participating physicians to gain feedback on our approach. Video-recordings were double-coded by two medically trained researchers, independent of the study team and each other, using an explicit checklist of key processes of care that we developed, from which we derived a process quality score. We also elicited a global quality rating from reviewers.
ResultsWe analysed 142 physician-patient consultations. The median process score given by both coders was 100 %. The modal overall rating category was ‘above standard’ (or 4 on a scale of 1–5). Coders agreed on which rating to assign only 44 % of the time (weighted Cohen’s kappa = 0.26). We found in three-level hierarchical modelling that the majority of variance in process scores was explained by coder disagreement. A very high correlation of 0.90 was found between the global quality rating and process quality score across all encounters. Participating physicians liked our approach, despite initial reservations about being observed.
ConclusionsVideo-observation is feasible and acceptable in this setting, and the quality of consultations was high. However, we found that rater agreement is low but comparable to other modalities that involve expert clinician judgements about quality of care including in-person direct observation and case note review. We suggest ways to improve scoring consistency including careful rater selection and improved design of the measurement procedure for the process score.
Original languageEnglish
Article number488
JournalBMC Health Services Research
Issue number1
Publication statusPublished - 22 May 2021

Bibliographical note

Funding Information:
We would like to thank the physicians and patients at UCH in Ibadan, Nigeria who took part in this study. We thank colleagues at the University of Ibadan and UCH for facilitating this research. We extend our thanks and appreciation to Dr Tawakalit Olubukola Salaam (Consultant Family Physician), who led the process of identifying eligible patients in the clinic.?Upon acceptance, NA had moved to Newcastle University, Population Health Sciences Institute and may be contacted [email protected].

Funding Information:
This research was funded by two grants awarded by the University of Warwick, UK (Global Research Priorities – International Development (GRP - ID) and GCRF Accelerator Fund). The research is part of the National Institute for Health Research (NIHR) Global Health Research Unit on Improving Health in Slums funded using UK aid from the UK Government to support global health research. The authors, NA, EO, OF, MMA, SIW, AO2 and RJL were supported by this NIHR grant. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care. The funder had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.


  • Adult
  • Child
  • Cross-Sectional Studies
  • Humans
  • Nigeria
  • Outpatient Clinics, Hospital
  • Physicians
  • Social Skills
  • low-and middle-income countries
  • ambulatory care
  • Quality of healthcare
  • video-observation
  • physicians
  • consultation quality

ASJC Scopus subject areas

  • Health Policy


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