The ‘Spiegelaarmethode’ offers general practitioners an accessible way to reflect on their work and engage in discussions with colleagues from their GP practice group. Through this method, GPs can apply peer review using their general practitioner information system (HIS-data). This leads to more effective care and more reliable research using GP data. The project was developed within ANHA, the academic workplace of the department ‘Huisartsgeneeskunde’, and is led by, among others, APH researcher Coralie Arends (research coordinator at ANHA) and Rik Roelofs (quality & education coordinator at ANHA).

The reason for the ‘Spiegelaarmethode’

Five years ago, the primary care groups united in the ‘Amsterdamse Huisartsenalliantie’ (AHa), representing 90% of the GPs in the Amsterdam region. The care groups had already been collaborating with ANHA, but the merger and establishment of AHa marked a major step forward in collaboration within Amsterdam. The ‘Spiegelaarmethode’ is a great example of this progress. General practitioners want more autonomy and responsibility in their quality development, and the ‘Spiegelaarmethode’ contributes to this: this tool helps GPs reflect on the care in their own practice.

Roelofs and Arends: “The development of the ‘Spiegelaarmethode’ has been a process in which support, participation, involvement, and impact have played an important role from the start. It was not developed in an ivory tower, but with all relevant stakeholders both inside and outside Amsterdam UMC.”

Collaboration between practice and science

General practitioners who are affiliated with ANHA share their data with the network, after which ANHA applies the ‘Spiegelaarmethode’ to their specific data selection. This allows ANHA to use the data for more reliable and accurate research, while GPs receive reflection material tailored specifically to their own practice. This approach provides benefits both for practice and for science.

"As a general practitioner, I feel responsible for a healthy population and effective care. As quality & education coordinator at ANHA, I feel responsible for improving the quality of care"
Rik Roelofs
"From my perspective as a PhD clinical epidemiologist, I find audit & feedback extremely valuable for general practitioners because it gives direct insight into their own actions and can also contribute to adjustments in their behavior, thus optimizing care. It can also lead to better registration. This results in better and more reliable datasets, which allow for high-level research"
Coralie Arends

Effectiveness as the key to impact

Roelofs and Arends emphasize that the effectiveness of the ‘Spiegelaarmethode’ is crucial for creating impact. Research shows that audit & feedback is most effective when there is significant room for improvement, when there is guidance during the reflection session, when multiple reflection sessions take place on the same topic, and when the audit and feedback is provided both verbally and in writing. Additionally, clear goals and action plans should follow the first session. By integrating these elements, the ‘Spiegelaarmethode’ aims to be a valuable tool for achieving impact.

Development and next steps

The ‘Spiegelaarmethode’ is now at the stage where the project phase has been completed and is ready for further rollout in the region. The project is funded by AHa, Amsterdam UMC, and partially by a ZonMw grant awarded in December 2024.

Roelofs and Arends: “The foundation is there, and the structure is in place. Surveys, workbooks, PowerPoint presentations are available, and there is administrative support. The next step is for a large number of GP practice groups to start reflecting using the ‘Spiegelaarmethode’. That is the challenge for now.”

ANHA and AHa aim to have as many general practitioners as possible benefit from the ‘Spiegelaarmethode’, so the quality of care in as many GP practices as possible can be improved. GPs can use the Mirror ‘Spiegelaarmethode’ when their GP practice group is affiliated with ANHA. The focus is therefore on increasing the number of GP practices that join ANHA.

Finally, Roelofs and Arends point out that the ‘Spiegelaarmethode’ from ANHA can provide valuable insights for your research domain. It is advisable to consult with the research, audit & feedback coordinator at ANHA about the possibilities this offers for your research.

More information can be found on the ANHA webpage.