title: Quality improvement through clinical communities: eight lessons for practice.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Diverse literatures were identified, analysed and synthesised in a manner that accounted for the heterogeneity of methods, models and contexts they covered.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Leicester, Social Science Research Group, Department of Health Sciences, Leicester, UK.
authors.forename: Emma-Louise
authors.initials: EL
authors.lastname: Aveling
authors.forename: Graham
authors.initials: G
authors.lastname: Martin
authors.forename: Natalie
authors.initials: N
authors.lastname: Armstrong
authors.forename: Jay
authors.initials: J
authors.lastname: Banerjee
authors.forename: Mary
authors.initials: M
authors.lastname: Dixon-Woods
mesh_terms: D003299:Cooperative Behavior; D058016:Health Facility Administration; D007857:Leadership; D058996:Quality Improvement; D014481:United States