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Collaborative working within UK NHS secondary care and across sectors for COPD and the impact of peer review :\ud qualitative findings from the UK National COPD Resources\ud and Outcomes Project

By Carol Rivas, Stephen Abbott, Stephanie J. C. Taylor, Aileen Clarke, C. Michael Roberts, Robert Stone and Chris Griffiths


Introduction: We investigated the effects on collaborative work within the UK National Health Service (NHS) of an intervention for service quality improvement: informal, structured, reciprocated, multidisciplinary peer review with feedback and action plans. The setting was care for chronic obstructive pulmonary disease (COPD).\ud Theory and methods: We analysed semi-structured interviews with 43 hospital respiratory consultants, nurses and general managers at 24 intervention and 11 control sites, as part of a UK randomised controlled study, the National COPD Resources and Outcomes Project (NCROP), using Scott’s conceptual framework for action (inter-organisational, intra-organisational, inter-professional and inter-individual). Three areas of care targeted by NCROP involved collaboration across primary and secondary care.\ud Results: Hospital respiratory department collaborations with commissioners and hospital managers varied. Analysis suggested that this is related to team responses to barriers. Clinicians in unsuccessful collaborations told ‘atrocity stories’ of organisational, structural and professional barriers to service improvement. The others removed barriers by working with government and commissioner agendas to ensure continued involvement in patients’ care. Multidisciplinary peer review facilitated collaboration between participants, enabling them to meet, reconcile differences and exchange ideas across boundaries.\ud Conclusions: The data come from the first randomised controlled trial of organisational peer review, adding to research into UK health service collaborative work, which has had a more restricted focus on inter-professional relations. NCROP peer review may only modestly improve collaboration but these data suggest it might be more effective than top-down exhortations to change when collaboration both across and within organisations is required

Topics: RC, RA
Publisher: Igitur, Utrecht Publishing & Archiving Services
Year: 2010
OAI identifier: oai:wrap.warwick.ac.uk:3427

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  14. (1987). Merger and autonomy: reaping the benefits of both. Health Progress
  15. (2005). our care, our say a new direction for community services; supporting people with long-term conditions: an NHS and social care model to support local innovation and integration. London: Department of Health;
  16. (1988). Policy and provision for special educational needs: implementing the 1981 Education Act. doi
  17. (1998). Quality management in the medical specialties: the use of channels and dikes in improving health care in The Netherlands. The Joint Commission Journal on Quality Improvement
  18. Redesigning health care. doi
  19. (2004). Royal College of Physicians and British Thoracic Society. Report of the 2003 National COPD Audit. In: Clinical Effectiveness and Evaluation Unit (ed). London: Royal College of Physicians;
  20. (1997). Secretary of State for Health. The new NHS. London: Stationery Office;
  21. (1992). Shaping strategic change—the case of the NHS in the 1980s. Public Money and Management doi
  22. Strategic marketing and clinical management in health care: a possible way forward. doi
  23. Supervising professional work under new public management: evidence from an “invisible trade”. doi
  24. The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks. doi
  25. (1995). The correspondence bias.
  26. (1967). The discovery of grounded theory. doi
  27. (1992). The expertise of the change agent: public performance and backstage activity. Hemel Hempstead: Prentice-Hall;
  28. (2000). The NHS manager, a view from the bridge. doi
  29. (1959). The presentation of self in everyday life. Garden City,
  30. The UK National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project (NCROP)—A feasibility study of large scale clinical service peer review. doi
  31. (1995). Troubled times: the context of interprofessional collaboration. In: Soothill
  32. (2006). Using thematic analysis in psychology. doi
  33. (2010). What counts is what works’? New Labour and partnerships in public health. doi
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