Quality circles for quality improvement in primary health care: Their origins, spread, effectiveness and lacunae– A scoping review

Abstract

Quality circles or peer review groups, and similar structured small groups of 6–12 health care professionals meet regularly across Europe to reflect on and improve their standard practice. There is debate over their effectiveness in primary health care, especially over their potential to change practitioners’ behaviour. Despite their popularity, we could not identify broad surveys of the literature on quality circles in a primary care context. Our scoping review was intended to identify possible definitions of quality circles, their origins, and reported effectiveness in primary health care, and to identify gaps in our knowledge. We searched appropriate databases and included any relevant paper on quality circles published until December 2017. We then compared information we found in the articles to that we found in books and on websites. Our search returned 7824 citations, from which we identified 82 background papers and 58 papers about quality circles. We found that they originated in manufacturing industry and that many countries adopted them for primary health care to continuously improve medical education, professional development, and quality of care. Quality circles are not standardized and their techniques are complex. We identified 19 papers that described individual studies, one paper that summarized 3 studies, and 1 systematic review that suggested that quality circles can effectively change behaviour, though effect sizes varied, depending on topic and context. Studies also suggested participation may affirm self-esteem and increase professional confidence. Because reports of the effect of quality circles on behaviour are variable, we recommend theory-driven research approaches to analyse and improve the effectiveness of this complex intervention.

Use of quality circles for primary care providers in 24 European countries: an online survey of European Society for Quality and Safety in family practice delegates

“…Portugal’s primary care system has developed rapidly over the past few years, with a corresponding development in QCs. Similarly, the QC participation rate in France increased from ‘no QCs in existence’ in 2000 to involving at least 10% of GPs in 2015, as recorded in studies and numerous projects [1,26]. The reasons for different development patterns in different countries are not fully clear.…”

“…QCs help participants link evidence to everyday practice, deal with uncertainty and feel secure in their professional roles. Participation may strengthen team-based strategies for preventing errors, reduce burnout, and help practices retain practitioners [1].…”

<p>Implementation and Promotion of Quality Control Circle: A Starter for Quality Improvement in Chinese Hospitals</p>

“…Previous literatures suggest that the QCC used in health care is likely to be a powerful technique for facilitating high-quality healthcare and improved outcomes. [14][15][16][17][18][19] The study by Wang et al 14 reviewed the tangible and intangible achievements of 92 QCCs carried out in a medical institution in Zhejiang province. This study showed that QCCs improve performance indicators in terms of reducing costs and internal errors, and improving work quality, patient satisfaction and economic performance.…”

Where do Peer Review Groups fit in the international Continuing Professional Development literature?

“…Small groups have been widely used as a learning format in medical CPD in central and northern continental Europe since the 1970s, [12][13][14][15] and later in Canada and Scotland, 16 and Ireland, 17 most commonly in primary care, but also in psychiatry in Europe 18 and Australia and New Zealand. Such groups are variously named and take a range of formats (see Table 1).…”