Perceptions of changes in practice following peer review in the National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project

Peer Review Processes for Quality Improvement in Health Care Settings and Their Implications for Health Care Professionals: A Meta-Ethnography

INTRODUCTION

Peer review processes are used to improve professional practice in health care, although no synthesis of existing studies has yet been undertaken. These processes are included in the UK professional revalidation processes for medical practitioners and nurses and midwives but not for allied health professionals. The purpose of this review was to identify, appraise, and synthesize the available qualitative evidence regarding health care professionals' experiences and views about peer review processes and to explore the implications for health care professionals in the United Kingdom.

METHODS

Qualitative review using meta-ethnography, reported according to Meta-ethnography Reporting Guidance guidance. Search strategy was developed using MeSH headings. The following data sources were searched: Cumulative Index to Nursing and Allied Health Literature, MEDLINE, and Ovid full text (between May 2007 and May 2019) (one reviewer with librarian support) plus manual searching. Screening, data extraction, and evaluation were undertaken independently by two reviewers. Studies were independently appraised for quality by two reviewers to identify concepts which were compared and developed into a conceptual model by the team.

RESULTS

Thirteen studies (937 participants) were included. Findings explored peer review processes and three key components, namely, purpose, process, and peers. Participants' perceptions of peer review processes were categorized by four main concepts: value/benefits, reflection/shared learning, anxiety about the process, and how to improve "buy-in."

DISCUSSION

Evidence supports the introduction and use of peer review processes as a quality improvement tool. Further research exploring whether/how to incorporate peer review processes into the process of assessing continuing fitness to practice for allied health professionals seems appropriate. The time and resources required to implement peer review processes are considered barriers to implementation.

Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis

OBJECTIVES

External inspections are widely used to improve the quality of care. The effects of inspections remain unclear and little is known about how they may work. We conducted a narrative synthesis of research literature to identify mediators of change in healthcare organisations subject to external inspections.

METHODS

We performed a literature search (1980-January 2020) to identify empirical studies addressing change in healthcare organisations subject to external inspection. Guided by the Consolidated Framework for Implementation Research, we performed a narrative synthesis to identify mediators of change.

RESULTS

We included 95 studies. Accreditation was the most frequent type of inspection (n=68), followed by statutory inspections (n=19), and external peer review (n=9). Our findings suggest that the regulatory context in which the inspections take place affect how they are acted on by those being inspected. The way inspections are conducted seem to be critical for how the inspection findings are perceived and followed up. Inspections can engage and involve staff, facilitate leader engagement, improve communication and enable the creation of new networks for reflection on clinical practice. Inspections can contribute to creating an awareness of the inspected organisation's current practice and performance gaps, and a commitment to change. Moreover, they can contribute to facilitating the planning and implementation of change, as well as self-evaluation and the use of data to evaluate performance.

CONCLUSIONS

External inspections can affect different mediators of organisational change. The way and to what extent they do depend on a range of factors related to the outer setting, the way inspections are conducted and how they are perceived and acted on by the inspected organisation. To improve the quality of care, the organisational change processes need to involve and impact the way care is delivered to the patients.

Emergent programme theories of a national quality register - a longitudinal study in Swedish elderly care

RATIONALE, AIM, AND OBJECTIVE

This study aimed to explore programme theories of a national quality register. A programme theory is a bundle of assumptions underpinning how and why an improvement initiative functions. The purpose was to examine and establish programme theories of a national quality register widely used in Sweden: Senior alert. The paper reports on how programme theories among change recipients emerge in relation to the established programme theory of the initiator.

METHODS

A qualitative approach and a longitudinal research design were used. To develop programme theories among change recipients, individual semistructured interviews were conducted. Three sets of interviews were conducted in the period of 2011 to 2013, totalling 22 interviews. In addition, 4 participant observations were made. To develop the initiator's programme theory, an iterative multistage collaboration process between the researchers and the initiator was used. A directed content analysis was used to analyse data.

FINDINGS

The initiator and change recipients described similar programme logics, but differing programme theories. With time, change recipients' programme theories emerged. Their programme theories converged and became more like the programme theory of the initiator.

CONCLUSIONS

This study has demonstrated the importance of making both the initiator's and change recipients' programme theories explicit. To learn about conditions for improvement initiatives, comparisons between their programme theories are valuable. Differences in programme theories provide information on how initiators can customize support for their improvement initiatives. Similar programme logics can be underpinned by different programme theories, which can be deceptive. Programme theories emerge over time and need to be understood as dynamic phenomena.

Evaluating the impact of accreditation and external peer review

Purpose

– Accreditation and external peer review play important roles in assessing and improving healthcare quality worldwide. Evidence on the impact on the quality of care remains indecisive because of programme features and methodological research challenges. The purpose of this paper is to create a general methodological research framework to design future studies in this field.

Design/methodology/approach

– A literature search on effects of external peer review and accreditation was conducted using PubMed/Medline, Embase and Web of Science. Three researchers independently screened the studies. Only original research papers that studied the impact on the quality of care were included. Studies were evaluated by their objectives and outcomes, study size and analysis entity (hospitals vs patients), theoretical framework, focus of the studied programme, heterogeneity of the study population and presence of a control group.

Findings

– After careful selection 50 articles were included out of an initial 2,025 retrieved references. Analysis showed a wide variation in methodological characteristics. Most studies are performed cross-sectionally and results are not linked to the programme by a theoretical framework.

Originality/value

– Based on the methodological characteristics of previous studies the authors propose a general research framework. This framework is intended to support the design of future research to evaluate the effects of accreditation and external peer review on the quality of care.