Quality circles for quality improvement in primary health care 2 40 Abstract 41 Background 42 Quality circles, or similarly structured small groups in primary health care, such as peer review 43 groups, consist of 6 to 12 professionals from the same background who meet regularly to improve 44 their standard practice. This paper reports the results from a scoping search performed to clarify 45 possible effectiveness, knowledge gaps, underlying concepts and significance.46 Objectives 47 To gain insight into knowledge gaps and understanding of the effectiveness, origins and significance 48 of quality circles.49 Methods 50 A search strategy was developed starting with 'quality circle' in PubMed and the index terms from 51 those articles revealed were then used as search terms to identify further papers. Repeating this process 52 in collaboration with a librarian, search strings relating to quality circles were built, and databases 53 searched up to December 2017. Any paper on structured quality circles or related small group work in 54 primary health care was included when relevant to the objectives.
Results
56From 11973 citations, 82 background papers and 58 key papers were identified, in addition to 12 57 books and 10 websites. 19 studies, one paper summarizing three studies and one systematic review 58 suggest that quality circles can be effective in behaviour change, though with varying effect sizes.59 Quality circles and their techniques are complex, as they are not standardized, and changes seem to 60 depend on the topic and context, which requires further research into how and why they work in order 61 to improve them. From their origins in industry, they are now used in primary health care in many 62 countries for continuous medical education, continuous professional development and quality 63 improvement.
64
Conclusion
65The evidence on quality circles indicates that they can successfully change general practitioner 66 behaviour. As they are a complex intervention, theory-driven research approaches are needed to . CC-BY 4.0 International license It is made available under a (which was not peer-reviewed) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint . http://dx.doi.org/10.1101/387605 doi: bioRxiv preprint first posted online Aug. 8, 2018; Quality circles for quality improvement in primary health care 3 67 understand and improve their effectiveness. This is of major importance because they play an 68 important role in quality improvement in primary health care in many countries.
79There are systematic reviews (SRs) on the tools used in these groups but there is still doubt as 80 to whether they make participants improve their practice, even if the tools are used in combination.81 This paper reports the results of a scoping review to map areas of uncertainty regarding QC 82 effectiveness, thereby indicating where further research is needed. It maps size and type of evidence 83 and describes original intentions and report...