What makes British general practitioners take part in a quality improvement scheme?

OBJECTIVES: To understand the reasons for the apparent success of a quality improvement scheme designed to produce widespread changes in chronic disease management in primary care. METHODS: Purposeful sample of 36 primary care staff, managers and specialists. Qualitative analysis of 27 interviews in East Kent Health Authority area, where, over a three-year period, more than three-quarters of general practitioners (GPs) and enrolled in a quality improvement programme which required them to meet challenging chronic disease management targets (PRImary Care Clinical Effectiveness--PRICCE). RESULTS: Major changes in clinical practice appeared to have taken place as a result of participation in PRICCE. The scheme was significantly dependent on leadership from the health authority and on local professional support. Factors that motivated GPs to take part in the project included: a desire to improve patient care; financial incentives; maintenance of professional autonomy in how to reach the targets; maintenance of professional pride; and peer pressure. Good teamworking was essential to successful completion of the project and often improved as a result of taking part. The scheme included a combination of interventions known to be effective in producing professional behavioural change. CONCLUSIONS: When managerial vision is aligned to professional values, and combined with a range of interventions known to influence professional behaviour including financial incentives, substantial changes in clinical practice can result. Lessons are drawn for future quality improvement programmes in the National Health Service.     

Family Practice--what makes a good review?

Background Reviews and reviewers are an essential part of the publishingprocess. Despite well-described drawbacks, peer review remainsa cornerstone of the evaluation, revision and selection of papersfor publication. Reviewers’ comments are an importantpart of editorial decision making. Reviews are of widely variable quality and utility. This variationhas been subject to a good deal of research, and some of thecharacteristics of good reviewers are beginning to emerge, aswell as strategies, particularly feedback and training, whichare successful in improving the quality and usefulness of peerreviews. One important factor is, of course, the clarity ofinstructions given by editors and their journals to reviewers.Many journals have approached this by using structured pro-formas,and encouraging on-line reviewing. My own experience of thisis that the process can feel restrictive and reductionist, andtends to encourage convergent and introspective thinking