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1.  The challenge of communication in interpreted consultations in diabetes care: a mixed methods study 
The British Journal of General Practice  2013;63(607):e125-e133.
The experience of diabetes care for individuals from minority ethnic groups, particularly individuals of Bangladeshi origin, shows they are at a significant disadvantage.
To identify the challenges of interpreted consultations for healthcare providers and to explain the disadvantage experienced by patients from minority groups who have diabetes.
Design and setting
Comparison of 12 interpreted consultations with 24 consultations involving fluent English speakers in four primary healthcare centres in Tower Hamlets, east London, UK.
Content analysis of video recordings of routine diabetes review consultations in primary care, involving 36 patients, nine nurses or healthcare assistants, and six interpreters.
Interpreted consultations were as long as same-language consultations but patients said less. The incidence of misunderstandings was similar but patients in interpreted consultations asked fewer questions. Indicators of social distance in interpreted consultations included less humour and less discussion of the patient’s feelings or personal circumstances. Patients in interpreted consultations were less likely to raise issues unrelated to diabetes, to discuss their own ideas about health, or to talk about clinical parameters. Providers commonly addressed English-speaking patients directly but usually addressed patients through interpreters using the third person. Interpreters sometimes changed the meaning or did not translate speech, and they added their own comments.
The findings explain some of the known problems of diabetes care for individuals from ethnic minorities. Effective training for interpreters and care providers is needed to reduce social distance and to facilitate patients’ involvement in self-management.
PMCID: PMC3553638  PMID: 23561691
communication; diabetes mellitus; ethnic groups; multilingualism; primary health care
2.  Collaborative working within UK NHS secondary care and across sectors for COPD and the impact of peer review: qualitative findings from the UK National COPD Resources and Outcomes Project 
We investigated the effects on collaborative work within the UK National Health Service (NHS) of an intervention for service quality improvement: informal, structured, reciprocated, multidisciplinary peer review with feedback and action plans. The setting was care for chronic obstructive pulmonary disease (COPD).
Theory and methods
We analysed semi-structured interviews with 43 hospital respiratory consultants, nurses and general managers at 24 intervention and 11 control sites, as part of a UK randomised controlled study, the National COPD Resources and Outcomes Project (NCROP), using Scott's conceptual framework for action (inter-organisational, intra-organisational, inter-professional and inter-individual). Three areas of care targeted by NCROP involved collaboration across primary and secondary care.
Hospital respiratory department collaborations with commissioners and hospital managers varied. Analysis suggested that this is related to team responses to barriers. Clinicians in unsuccessful collaborations told ‘atrocity stories’ of organisational, structural and professional barriers to service improvement. The others removed barriers by working with government and commissioner agendas to ensure continued involvement in patients' care. Multidisciplinary peer review facilitated collaboration between participants, enabling them to meet, reconcile differences and exchange ideas across boundaries.
The data come from the first randomised controlled trial of organisational peer review, adding to research into UK health service collaborative work, which has had a more restricted focus on inter-professional relations. NCROP peer review may only modestly improve collaboration but these data suggest it might be more effective than top-down exhortations to change when collaboration both across and within organisations is required.
PMCID: PMC2948684  PMID: 20922063
collaboration; inter-organizational; inter-professional; quality improvement; respiratory disease

Results 1-2 (2)