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The Maturity Matrix is a tool designed in the UK to assess family practice organisational development and to stimulate quality improvement. It is practice‐led, formative and undertaken by a practice team with the help of trained facilitators. The aim of this study is to assess the Maturity Matrix as a tool and an organisational development measure in European family practice settings.

Using a convenience sample of 153 practices and 11 facilitators based in the UK, Germany, The Netherlands, Switzerland and Slovenia, feasibility was assessed against six criteria: completion; coverage; distribution; scaling; translation; and missing data. Information sources were responses to evaluation questionnaires by facilitators and completed Maturity Matrix profiles.

All practices taking part completed the Maturity Matrix sessions successfully. The Netherlands, the UK and Germany site staff suggested including additional dimensions: interface between primary and secondary care; access; and management of expendable materials. Maturity Matrix scores were normally distributed in each country. Scaling properties, translation and missing data suggested that the following dimensions are most robust across the participating countries: clinical performance audit; prescribing; meetings; and continuing professional development. Practice size did not make a significant difference to the Maturity Matrix profile scores.

The study suggests that the Maturity Matrix is a feasible and valuable tool, helping practices to review organisational development as it relates to healthcare quality. Future research should focus on developing dimensions that are generic across European primary care settings.

People with learning disabilities want and value friendships and close, intimate, or romantic relationships. However, many people with learning disabilities are socially and emotionally lonely. The purpose of this paper is to describe a novel intervention, using a narrative therapy based group approach, which aimed to ameliorate the negative effects of loneliness in adult men with a mild learning disability.

This study explored the group process, examined participants' experiences of the narrative therapy approach, and used an amended version of the UCLA loneliness scale (3rd ed.) to evaluate the effectiveness of a narrative therapy group approach.

The group enabled participants to develop “experience near” descriptions of loneliness and its effects and to identify and strengthen their abilities, strengths, and resources. Qualitative feedback from participants indicated that the group was experienced positively and helped participants to feel less lonely. Quantitative feedback from an adapted version of the UCLA loneliness scale suggested that most participants felt less lonely following the intervention.

There are several limitations of the current study. Most importantly, because of the small sample size (n=5), the results of the current study lack generalisability. Future, larger‐scale research should be carried out to address these limitations.

The current study draws attention to a significant problem experienced by many people with a learning disability. It also adds to the emerging evidence that narrative therapy approaches may be useful within learning disability contexts.

This paper aims to evaluate the maturity matrix (MM) (a facilitated formative self‐assessment tool for organisational development in primary care) on satisfaction, differences between GP and staff, the extent to which practice teams worked on goals set, and to identify suggestions for change to MM.

The approach taken was a cross‐sectional survey administered to all participants by mail in 57 family practices, 278 participants, (143 GPs; 135 staff) in Denmark, one year after participating in the MM project.

At practice level 44 returned at least one questionnaire. At participant level, 144 returned the questionnaire: 82 GPs; 62 staff. A total of 93 gave positive statements on satisfaction with MM, 16 stated initial expectations were not met, 79 would recommend MM to colleagues. Differences between GPs and staff were only statistically significant regarding “increased insight into organisation of work after participation in the MM project”. There was a tendency that GPs were more positive and likely to give an opinion. A total of 22 planned how to meet the goals set at the first MM meeting and 18 felt that they achieved them. In 24 out of 44 practices MM was stated to contribute new ways of working. A total of 12 of 144 stated that they needed more follow‐up support.

The results indicate that MM is a workable method to assess and gain insight into practice organisation with no major differences between GPs and staff.

The paper examines participants views' on MM one year after introduction.

Quality improvement (QI) processes in family medicine are becoming increasingly complex. Their influence on the organisation of the sector and on the daily work processes is profound and increasing. The literature indicates that many ethical issues are arising from QI work. Therefore this paper aims to identify the experiences of professionals involved in planning and performing QI programmes in European family medicine on the ethical implications involved in those processes.

Four focus groups were carried out with 29 general practitioners (GPs) and administrators of general practice quality work in Europe. Two focus groups comprised EQuiP members and two focus groups comprised attendees to an invitational conference on QI in family medicine held by EQuiP in Barcelona in November 2006.

Four overarching themes were identified, including implications of using patient data, prioritising QI projects, issues surrounding the ethical approval dilemma and the impact of QI. Each theme was accompanied by an identified solution.

Prioritising is necessary and in doing that GPs should ensure that a variety of work is conducted so that some patient groups are not neglected. Transparency and flexibility on various levels is necessary to avoid harmful consequences of QI in terms of bureaucratisation, increased workload and burnout on part of the GP and harmful effects on the doctor‐patient relationship. There is a need to address the system of approval for national QI programmes and QI projects utilising more sophisticated methodologies.

This study provides data from GPs who are experienced quality improvers across 17 countries. Many ethical issues were identified and it was possible to clearly map the themes and their relationships and to summarise the identified solutions from an international perspective.

The editor, Head of the Business Library at Western Michigan University, would be interested to receive communications from persons knowledgeable in the business field, for purposes of submitting reviews. Business Reference Review will attempt to review recent reference materials in the form of books and other media. The intent is to review the contents of business reference sources, enabling those engaged in the selection of these materials to make better judgements, thus utilizing their book budgets more efficiently. Please address review copies of new items for Business Reference Review directly to the editor in care of the WMU Business Library, Kalamazoo, Michigan, 49008. Of course, the items reviewed here are not available from the editor but may be obtained from the normal trade sources.

The editor, Acting Head of the Business Library at Western Michigan University, would be interested to receive communications from persons knowledgeable in the business field, for purposes of submitting reviews. Business Reference Review will attempt to review recent reference materials in the form of books and other media. The intent is to review the contents of business reference sources, enabling those engaged in the selection of these materials to make better judgements, thus utilizing their book budgets more efficiently. Please address review copies of new items for Business Reference Review directly to the editor in care of the WMU Business Library, Kalamazoo, Michigan, 49008. Of course, the items reviewed here are not available from the editor but may be obtained from the normal trade sources.

Much work about health reform and systems improvement in healthcare looks at shortcomings and universal problems facing health systems, but rarely are accomplishments dissected and analyzed internationally. The purpose of this paper is to address this knowledge gap by examining the lessons learned from health system reform and improvement efforts in 60 countries.

In total, 60 low-, middle- and high-income countries provided a case study of successful health reform, which was gathered into a compendium as a recently published book. Here, the extensive source material was re-examined through inductive content analysis to derive broad themes of systems change internationally.

Nine themes were identified: improving policy, coverage and governance; enhancing the quality of care; keeping patients safe; regulating standards and accreditation; organizing care at the macro-level; organizing care at the meso- and micro-level; developing workforces and resources; harnessing technology and IT; and making collaboratives and partnerships work.

These themes provide a model of what constitutes successful systems change across a wide sample of health systems, offering a store of knowledge about how reformers and improvement initiators achieve their goals.

Few comparative international studies of health systems include a sufficiently wide selection of low-, middle- and high-income countries in their analysis. This paper provides a more balanced approach to consider where achievements are being made across healthcare, and what we can do to replicate and spread successful examples of systems change internationally.