title: Reciprocal peer review for quality improvement: an ethnographic case study of the Improving Lung Cancer Outcomes Project.
abstract: BACKGROUND
  Peer review offers a promising way of promoting improvement in health systems, but the optimal model is not yet clear. We aimed to describe a specific peer review model-reciprocal peer-to-peer review (RP2PR)-to identify the features that appeared to support optimal functioning.
  
  
  METHODS
  We conducted an ethnographic study involving observations, interviews and documentary analysis of the Improving Lung Cancer Outcomes Project, which involved 30 paired multidisciplinary lung cancer teams participating in facilitated reciprocal site visits. Analysis was based on the constant comparative method.
  
  
  RESULTS
  Fundamental features of the model include multidisciplinary participation, a focus on discussion and observation of teams in action, rather than paperwork; facilitated reflection and discussion on data and observations; support to develop focused improvement plans. Five key features were identified as important in optimising this model: peers and pairing methods; minimising logistic burden; structure of visits; independent facilitation; and credibility of the process. Facilitated RP2PR was generally a positive experience for participants, but implementing improvement plans was challenging and required substantial support. RP2PR appears to be optimised when it is well organised; a safe environment for learning is created; credibility is maximised; implementation and impact are supported.
  
  
  CONCLUSIONS
  RP2PR is seen as credible and legitimate by lung cancer teams and can act as a powerful stimulus to produce focused quality improvement plans and to support implementation. Our findings have identified how RP2PR functioned and may be optimised to provide a constructive, open space for identifying opportunities for improvement and solutions.
authors.affiliation: Department of Health Sciences, Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, UK. eea5@le.ac.uk
authors.forename: Emma-Louise
authors.initials: EL
authors.lastname: Aveling
authors.forename: Graham
authors.initials: G
authors.lastname: Martin
authors.forename: Senai
authors.initials: S
authors.lastname: Jiménez García
authors.forename: Lisa
authors.initials: L
authors.lastname: Martin
authors.forename: Georgia
authors.initials: G
authors.lastname: Herbert
authors.forename: Natalie
authors.initials: N
authors.lastname: Armstrong
authors.forename: Mary
authors.initials: M
authors.lastname: Dixon-Woods
authors.forename: Ian
authors.initials: I
authors.lastname: Woolhouse
mesh_terms: D000884:Anthropology, Cultural; D006801:Humans; D008175:Lung Neoplasms / Q000208:ethnology / Q000628:therapy*; D019982:Organizational Case Studies; D017063:Outcome Assessment, Health Care / Q000592:standards*; D010348:Patient Care Team / Q000458:organization & administration; D018024:Peer Review, Health Care / Q000379:methods*; D010865:Pilot Projects; D036301:Qualitative Research; D058996:Quality Improvement