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

Abstract

The purpose of this paper is to examine perceptions of local service change and concepts of change amongst participants in a UK nationwide randomised controlled trial of informal, structured, reciprocated, multidisciplinary peer review with feedback to promote quality improvement: the National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project (NCROP). The paper takes the form of a qualitative study, involving semi-structured interviews with 43 hospital respiratory consultants, nurses and general managers at 24 intervention and 11 control NCROP sites. Thematic analysis resulted in adoption of Joss and Kogan's quality indicators as an analytic framework. The paper finds that peer review was associated with positive changes, which may lead to sustained service improvement. Differences existed in perceptions of change among clinicians and between clinicians and managers. "Generic changes" (e.g. changes in interpersonal relations or cultural changes), were often not perceived as change. The study highlights the significance of generic change in evaluations of change processes. Most participants were clinicians limiting inter-professional comparisons. Some clinical staff failed to recognise changes they accomplished or their significance, perceiving change differently to others within their professional group. These findings have implications for policy and research. They should be considered when developing frameworks for assessing quality improvements and staff engagement with change. This is the first qualitative study exploring participants' experience of peer review for quality improvement in healthcare. The study adds to previous research into UK health service improvement, which has had a more restricted focus on inter-professional differences.