title: Perceptions of changes in practice following peer review in the National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project.
abstract: OBJECTIVE
  The purpose of this paper is to examine perceptions of local service change and concepts of change amongst participants in a UK nationwide randomised controlled trial of informal, structured, reciprocated, multidisciplinary peer review with feedback to promote quality improvement: the National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project (NCROP).
  
  
  METHODS
  The paper takes the form of a qualitative study, involving semi-structured interviews with 43 hospital respiratory consultants, nurses and general managers at 24 intervention and 11 control NCROP sites. Thematic analysis resulted in adoption of Joss and Kogan's quality indicators as an analytic framework.
  
  
  RESULTS
  The paper finds that peer review was associated with positive changes, which may lead to sustained service improvement. Differences existed in perceptions of change among clinicians and between clinicians and managers. "Generic changes" (e.g. changes in interpersonal relations or cultural changes), were often not perceived as change.
  
  
  CONCLUSIONS
  The study highlights the significance of generic change in evaluations of change processes. Most participants were clinicians limiting inter-professional comparisons. Some clinical staff failed to recognise changes they accomplished or their significance, perceiving change differently to others within their professional group. These findings have implications for policy and research. They should be considered when developing frameworks for assessing quality improvements and staff engagement with change.
  
  
  CONCLUSIONS
  This is the first qualitative study exploring participants' experience of peer review for quality improvement in healthcare. The study adds to previous research into UK health service improvement, which has had a more restricted focus on inter-professional differences.
authors.affiliation: Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Rivas
authors.forename: Stephanie
authors.initials: S
authors.lastname: Taylor
authors.forename: Stephen
authors.initials: S
authors.lastname: Abbott
authors.forename: Aileen
authors.initials: A
authors.lastname: Clarke
authors.forename: Chris
authors.initials: C
authors.lastname: Griffiths
authors.forename: C Michael
authors.initials: CM
authors.lastname: Roberts
authors.forename: Robert
authors.initials: R
authors.lastname: Stone
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D007407:Interviews as Topic; D010043:Outcome and Process Assessment, Health Care; D010380:Peer Review; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000639:trends; D016032:Randomized Controlled Trials as Topic; D013222:State Medicine / Q000458:organization & administration / Q000592:standards* / Q000639:trends; D006113:United Kingdom