How and why do Quality Circles work for General Practitioners - a realist approach_development in Switzerland

Adrian Rohrbasser

Keywords: Quality Circle, Quality Improvement

Introduction:

To understand how and why general practitioners in quality circles (QC) reflect on and improve routine practice over time. To provide practical guidance for participants and facilitators to implement and for policy makers to organise this complex social intervention. Extension of this tool to other health care professionals in Switzerland

Method:

We collected data in four stages to develop and refine the programme theory of QCs: 1) co-inquiry with Swiss and European stakeholders to develop a preliminary programme theory; 2) realist review with systematic searches in MEDLINE, Embase, PsycINFO, and CINHAL (1980-2020) to extend the preliminary programme theory; 3) programme refinement through interviews with participants, facilitators, tutors and managers of quality circles; 4) consolidation through interviews and iterative searches for theories enabling us to strengthen the programme theory.

Results:

Requirements for successful QCs are governmental trust in GPs’ abilities to deliver quality improvement, training, access to educational material and performance data, protected time, and financial resources. Group dynamics strongly influence success; facilitators should ensure participants exchange knowledge and generate new concepts in a safe environment. Peer interaction promotes professional development and psychological well-being. With repetition, participants gain confidence to put their new concepts into practice.

Conclusions:

QCs can improve practice, promote professional development, and psychological well-being given adequate professional and administrative support.Development in Switzerland include a broad spectrum of health care professionals

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