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Title: Optimising the community-based approach to healthcare improvement: Comparative case studies of the clinical community model in practice
Authors: Aveling, E-L.
Martin, Graham
Herbert, G.
Armstrong, Natalie
First Published: 22-Nov-2016
Publisher: Elsevier
Citation: Social Science and Medicine In Press
Abstract: Community-based approaches to healthcare improvement are receiving increasing attention. Such approaches could offer an infrastructure for efficient knowledge-sharing and a potent means of influencing behaviours, but their potential is yet to be optimised. After briefly reviewing challenges to community-based approaches, we describe in detail the clinical community model. Through exploring clinical communities in practice, we seek to identify practical lessons for optimising this community-based approach to healthcare improvement. Through comparative case studies based on secondary analysis, we examine two contrasting examples of clinical communities in practice – the USA-based Michigan Keystone ICU programme, and the UK-based Improving Lung Cancer Outcomes Project. We focus on three main issues. First, both cases were successful in mobilising diverse communities: favourable starting conditions, core teams with personal credibility, reputable institutional backing and embeddedness in wider networks were important. Second, topdown input to organise regular meetings, minimise conflict and empower those at risk of marginalisation helped establish a strong sense of community and reciprocal ties, while intervention components and measures common to the whole community strengthened peer-norming effects. Third, to drive implementation, technical expertise and responsiveness from the core team were important, but so too were ‘hard tactics’ (e.g. strict limits on local customisation); these were more easily deployed where the intervention was standardised across the community and a strong evidence-base existed. Contrary to the idea of self-organising communities, our cases make clear that vertical and horizontal forces depend on each other synergistically for their effectiveness. We offer practical lessons for establishing an effective balance of horizontal and vertical influences, and for identifying the types of quality problems most amenable to community-based improvement.
DOI Link: 10.1016/j.socscimed.2016.11.026
ISSN: 0277-9536
eISSN: 0277-9536
Version: Publisher version
Status: Peer-reviewed
Type: Journal Article
Rights: © 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license ( Archived with reference to SHERPA/RoMEO and publisher website.
Appears in Collections:Published Articles, Dept. of Health Sciences

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