Early Years Toolkit​

Peer review is one way to evaluate work or change by one or more people involved in a service or system.  

It is vital when making improvements to capture the impact of the change as an individual, team and service user. Peer reviews are a form of self-regulation by qualified members of a profession within the relevant service or field. 

Peer review methods are used to maintain quality standards, improve performance, and provide credibility. Peer review can be categorised by the type of activity and by the field or profession in which the activity occurs, e.g., medical peer review.  It can also be used as a tool to teach others, provide updates on how the change has positively or negatively impacted colleagues, patients and families.  By which, then, helping to identify further improvements to modify the service or offer to meet the need. 

An example of using peer reviews to offer insights into a children's health hub's impact and approach to supporting children and families when accessing healthcare:

Collecting and correlating patient/family experience feedback can shape services to better meet need. It can result in patients using services efficiently and being more able to use clinical advice (Doyle et al, 2013). Good patient experience is, therefore, seen as a central outcome for the NHS, but there are different ideas about what constitutes patient experience, and feedback is collected in different ways. Both patients/families and staff want feedback to be heard and acted on. 

The different purposes of patient experience data direct the type of information collected, the way it is analysed and how it is subsequently utilised. Feedback can help assess service performance against expectations; for others, its primary purpose is to understand and respect individual experiences, while for others still, it is to improve services.

From an improvement lens, this can be to: 

• Improvement and redesign of services

• Reflection on staff behaviours

• Framing care as person-centred, rather than task or outcome-centred

• Staff and patients involved in the co-design of services

2 month review and thematic analysis of parent feedback attending the child health hub

All parents were asked to respond to the following questions:

• Do you prefer having this appointment at the GP surgery rather than the hospital  

• Has seeing a hospital paediatrician in the GP surgery changed the way you feel about your child's future care at the GP

• How likely are you to recommend this service to family & friends

Improvements made in response to feedback:

• Triaging the referrals urgently (within 1-2 days of receipt) 

• Booking in patients usually within 1 month (ranges from 1-6 weeks). 

• Requested the admin team to nudge parents about the appointment, potentially helping reduce DNA rates. 

• Overall improvement in parent and patient satisfaction.

Key Insights Arising From Parents' Feedback

Common Cause Variation

• Day in, day out, variation in a process

• Indicates stability and predictability

• If something falls under common cause variation, it is important not to overreact 

Special Cause Variation

• Indicates something different happened

• Not part of a stable process

• Always has a specific cause

• Should lead to appropriate action

The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change on a small scale (e.g., one patient, one day) in the real-world setting — by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method adapted for action-oriented learning (How to Improve: Model for Improvement: Testing Changes | Institute for Healthcare Improvement).