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Quality improvement through clinical communities: eight lessons for practice

Emma‐Louise Aveling (University of Leicester, Social Science Research Group, Department of Health Sciences, Leicester, UK)
Graham Martin (University of Leicester, Social Science Research Group, Department of Health Sciences, Leicester, UK)
Natalie Armstrong (University of Leicester, Social Science Research Group, Department of Health Sciences, Leicester, UK)
Jay Banerjee (University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK)
Mary Dixon‐Woods (Social Science Research Group, Department of Health Sciences, University of Leicester, Leicester, UK)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 18 May 2012

Abstract

Purpose

Approaches to quality improvement in healthcare based on clinical communities are founded in practitioner networks, peer influence and professional values. However, evidence for the value of this approach, and how to make it effective, is spread across multiple disciplines. The purpose of this paper is to review and synthesise relevant literature to provide practical lessons on how to use community‐based approaches to improve quality.

Design/methodology/approach

Diverse literatures were identified, analysed and synthesised in a manner that accounted for the heterogeneity of methods, models and contexts they covered.

Findings

A number of overlapping but distinct community‐based approaches can be identified in the literature, each suitable for different problems. The evidence for the effectiveness of these is mixed, but there is some agreement on the challenges that those adopting such approaches need to address, and how these can be surmounted.

Practical implications

Key lessons include: the need for co‐ordination and leadership alongside the lateral influence of peers; advantages of starting with a clear programme theory of change; the need for training and resources; dealing with conflict and marginalisation; fostering a sense of community; appropriate use of data in prompting behavioural change; the need for balance between “hard” and “soft” strategies; and the role of context.

Originality/value

The paper brings together diverse literatures with important implications for community‐based approaches to quality improvement, drawing on these to offer practical lessons for those engaged in improving healthcare quality in practice.

Keywords

Citation

Aveling, E., Martin, G., Armstrong, N., Banerjee, J. and Dixon‐Woods, M. (2012), "Quality improvement through clinical communities: eight lessons for practice", Journal of Health Organization and Management, Vol. 26 No. 2, pp. 158-174. https://doi.org/10.1108/14777261211230754

Publisher

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Emerald Group Publishing Limited

Copyright © 2012, Emerald Group Publishing Limited