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Reciprocal peer review for quality improvement: an ethnographic case study of the Improving Lung Cancer Outcomes Project
  1. Emma-Louise Aveling1,
  2. Graham Martin1,
  3. Senai Jiménez García2,
  4. Lisa Martin3,
  5. Georgia Herbert1,
  6. Natalie Armstrong1,
  7. Mary Dixon-Woods1,
  8. Ian Woolhouse4,5
  1. 1Department of Health Sciences, Social Science Applied to Healthcare Improvement, Research (SAPPHIRE) Group, University of Leicester, Leicester, UK
  2. 2Medtronic, Hospital Solutions. Hertfordshire, UK
  3. 3National Cancer Action Team, London, UK
  4. 4Clinical Standards Department, Royal College of Physicians, London, UK
  5. 5University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  1. Correspondence to Dr Emma-Louise Aveling, Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, UK; eea5{at}le.ac.uk

Abstract

Background Peer review offers a promising way of promoting improvement in health systems, but the optimal model is not yet clear. We aimed to describe a specific peer review model—reciprocal peer-to-peer review (RP2PR)—to identify the features that appeared to support optimal functioning.

Methods We conducted an ethnographic study involving observations, interviews and documentary analysis of the Improving Lung Cancer Outcomes Project, which involved 30 paired multidisciplinary lung cancer teams participating in facilitated reciprocal site visits. Analysis was based on the constant comparative method.

Results Fundamental features of the model include multidisciplinary participation, a focus on discussion and observation of teams in action, rather than paperwork; facilitated reflection and discussion on data and observations; support to develop focused improvement plans. Five key features were identified as important in optimising this model: peers and pairing methods; minimising logistic burden; structure of visits; independent facilitation; and credibility of the process. Facilitated RP2PR was generally a positive experience for participants, but implementing improvement plans was challenging and required substantial support. RP2PR appears to be optimised when it is well organised; a safe environment for learning is created; credibility is maximised; implementation and impact are supported.

Discussion RP2PR is seen as credible and legitimate by lung cancer teams and can act as a powerful stimulus to produce focused quality improvement plans and to support implementation. Our findings have identified how RP2PR functioned and may be optimised to provide a constructive, open space for identifying opportunities for improvement and solutions.

  • Quality improvement
  • Qualitative research
  • Social sciences

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