Optimising the community-based approach to healthcare improvement

Comparative case studies of the clinical community model in practice

Datos Bibliográficos

ID4589704
AutoresEmma-Louise Aveling (0000-0002-1259-9132, Harvard University, autor de correspondencia), Graham P Martins (0000-0003-1979-7577, University of Leicester), Graham Martins (0000-0001-7327-6997), Georgia Herbert (0000-0002-0422-826X, University Hospitals Bristol NHS Foundation Trust), N Armstrong (0000-0003-4046-0119, University of Leicester)
Año2017
Volumen173
Páginas96-103
Fecha de publicación2017-01-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaSocial Science & Medicine (JOURNAL)
Identificadores de la revistaISSN: 0277-9536 • E-ISSN: 1873-5347
EditorialElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2016.11.026
PMID27936423
OpenAlexW2555065092
IdiomaEN
Citas recibidas8
Referencias citadas27

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, top-down 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

Credibility · Embeddedness · Health care · Knowledge management · Political science · Public relations · Sociology · Computer Science · Healthcare Systems and Technology · Medicine · Mental Health and Patient Involvement · Nursing · Primary Care and Health Outcomes · Psychology