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Research & theory

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

Authors:

Carol Rivas,

About Carol

MSc, Research Fellow, Queen Mary University of London, Centre for Health Sciences, Barts and the London School of Medicine and Dentistry, 2 Newark Street, London E1 2AT, UK

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Stephen Abbott ,

About Stephen

MA (Econ), BA, Research Fellow, City University, City Community and Health Sciences, Incorporating St. Bartholomew School of Nursing and Midwifery, 20 Bartholomew Close, London EC1A 7QN, UK

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Stephanie J.C. Taylor,

About Stephanie J.C.

MBBS, MSc, MD, MRCGP, FFPH, Professor in Public Health and Primary Care, Queen Mary University of London, Centre for Health Sciences, Barts and the London School of Medicine and Dentistry, 2 Newark Street, London E1 2AT, UK

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Aileen Clarke,

About Aileen

Professor of Public Health and Health Services Research, Warwick Medical School, Health Sciences Research Institute, Coventry, CV4 7AL, UK

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C. Michael Roberts,

About C. Michael

MB ChB, MA, MD, FRCP, Associate Director, The Clinical Standards Department, The Royal College of Physicians, 11 St. Andrews Place, Regent’s Park, London NW1 4LE, UK

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Robert Stone,

About Robert

MBBS, BSc, PhD, FRCP, Associate Director, The Clinical Standards Department, The Royal College of Physicians, 11 St. Andrews Place, Regents Park, London NW1 4LE, UK

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Chris Griffiths

About Chris

MA, DPhil, FRCP, FRCGP, Professor of Primary Care, Queen Mary University of London, Centre for Health Sciences, Barts and the London School of Medicine and Dentistry, 2 Newark Street, London E1 2AT, UK

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Abstract

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.

How to Cite: Rivas C, Abbott S, Taylor SJC, Clarke A, Roberts CM, Stone R, et al.. 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. 2010;10(3):None. DOI: http://doi.org/10.5334/ijic.573
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Published on 29 Sep 2010.
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