Measuring the influence of colleagues on a consultant team's use of breast conserving surgery.
OBJECTIVE
The aim of this study was to examine potential reasons why the use of breast conserving surgery (BCS) for breast cancer varies substantially between hospital teams in England, and in particular to examine whether colleague influence has a role in influencing BCS rates locally.


METHODS
Routinely collected Hospital Episode Statistics (HES) data relating to 420 surgical teams in England who performed more than ten breast cancer operations during the financial year 2006/07 were used to identify predictors of team BCS use. Team BCS rates (as a proportion of all types of breast excision surgery) were subject to a regression analysis that incorporated, as independent variables, a range of patient, organizational, and local demographic factors, as well as the BCS rate of colleagues working alongside them in the same hospitals(s).


RESULTS
After adjusting for the effects of other variables, BCS use by colleagues working in the same hospital(s) was a significant predictor of a team's own BCS rate (standardized b = 0.224; p < .001), denoting a typical 3 percent increase in a team's BCS rate for every 10 percent increase in the BCS rate of colleagues.


CONCLUSIONS
The practice of colleagues seems to have a measurable influence upon a surgical team's BCS usage. Guidance from HTA organizations can set national standards about the use of new techniques and innovations, but dissemination can be either slowed down or accelerated by the influence of local colleagues. A strategy of disseminating guidance through professional networks or "local champions" could be a powerful avenue for change.
Hoy
Andrew R
AR
Centre for Public Health Excellence, National Institute for Health and Clinical Excellence, London, United Kingdom. andrew.hoy@nice.org.uk
Patrick
Hannah
H
Campbell
Bruce
B
Lyratzopoulos
Georgios
G
D001943:Breast Neoplasms / Q000601:surgery*; D004059:Diffusion of Innovation; D004739:England; D005260:Female; D006801:Humans; D033181:Information Dissemination; D015412:Mastectomy, Segmental; D008485:Medical Audit; D010348:Patient Care Team; D010818:Practice Patterns, Physicians'; D013222:State Medicine