Collaborative working within UK NHS secondary care and across sectors for COPD and the impact of peer review : qualitative findings from the UK National COPD Resources and Outcomes Project
Rivas, Carol, Abbott, Stephen, Taylor, Stephanie J. C., Clarke, Aileen, 1955-, Roberts, C. Michael, Stone, Robert and Griffiths, Chris. (2010) Collaborative working within UK NHS secondary care and across sectors for COPD and the impact of peer review : qualitative findings from the UK National COPD Resources and Outcomes Project. International Journal of Integrated Care, Vol.10 . ISSN 1568-4156
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Official URL: http://www.ijic.org/index.php/ijic/article/view/57...
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).
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.
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.
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.
|Item Type:||Journal Article|
|Subjects:||R Medicine > RC Internal medicine
R Medicine > RA Public aspects of medicine
|Divisions:||Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) > Warwick Evidence
Faculty of Medicine > Warwick Medical School
|Library of Congress Subject Headings (LCSH):||Lungs -- Diseases, Obstructive -- Treatment, Medical cooperation -- Great Britain, Great Britain. National Health Service, Medical care -- Quality control -- Great Britain, Hospitals -- Shared services|
|Journal or Publication Title:||International Journal of Integrated Care|
|Publisher:||Igitur, Utrecht Publishing & Archiving Services|
|Official Date:||29 September 2010|
|Access rights to Published version:||Open Access|
|Funder:||Health Foundation (Great Britain) (HF), GlaxoSmithKline, Boehringer Ingelheim Pharmaceuticals, AstraZeneca (Firm)|
1. Secretary of State for Health. The new NHS. London: Stationery Office; 1997.
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