Quality circles for quality improvement in primary health care: their effectiveness, gaps of knowledge, origins and significance – a scoping review

BackgroundQuality circles, or similarly structured small groups in primary health care, such as peer review groups, consist of 6 to 12 professionals from the same background who meet regularly to improve their standard practice. This paper reports the results from a scoping search performed to clarify possible effectiveness, knowledge gaps, underlying concepts and significance.ObjectivesTo gain insight into knowledge gaps and understanding of the effectiveness, origins and significance of quality circles.MethodsA search strategy was developed starting with ‘quality circle’ in PubMed and the index terms from those articles revealed were then used as search terms to identify further papers. Repeating this process in collaboration with a librarian, search strings relating to quality circles were built, and databases searched up to December 2017. Any paper on structured quality circles or related small group work in primary health care was included when relevant to the objectives.ResultsFrom 11973 citations, 82 background papers and 58 key papers were identified, in addition to 12 books and 10 websites. 19 studies, one paper summarizing three studies and one systematic review suggest that quality circles can be effective in behaviour change, though with varying effect sizes. Quality circles and their techniques are complex, as they are not standardized, and changes seem to depend on the topic and context, which requires further research into how and why they work in order to improve them. From their origins in industry, they are now used in primary health care in many countries for continuous medical education, continuous professional development and quality improvement.ConclusionThe evidence on quality circles indicates that they can successfully change general practitioner behaviour. As they are a complex intervention, theory-driven research approaches are needed to understand and improve their effectiveness. This is of major importance because they play an important role in quality improvement in primary health care in many countries.