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The purpose of this paper is to examine perceptions of local service change and concepts of change amongst participants in a UK nationwide randomised controlled trial of informal, structured, reciprocated, multidisciplinary peer review with feedback to promote quality improvement: the National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project (NCROP).

The paper takes the form of a qualitative study, involving semi‐structured interviews with 43 hospital respiratory consultants, nurses and general managers at 24 intervention and 11 control NCROP sites. Thematic analysis resulted in adoption of Joss and Kogan's quality indicators as an analytic framework.

The paper finds that peer review was associated with positive changes, which may lead to sustained service improvement. Differences existed in perceptions of change among clinicians and between clinicians and managers. “Generic changes” (e.g. changes in interpersonal relations or cultural changes), were often not perceived as change.

The study highlights the significance of generic change in evaluations of change processes. Most participants were clinicians limiting inter‐professional comparisons. Some clinical staff failed to recognise changes they accomplished or their significance, perceiving change differently to others within their professional group. These findings have implications for policy and research. They should be considered when developing frameworks for assessing quality improvements and staff engagement with change.

This is the first qualitative study exploring participants' experience of peer review for quality improvement in healthcare. The study adds to previous research into UK health service improvement, which has had a more restricted focus on inter‐professional differences.

The paper aims to take a reflective stance on the relationship between policy/evidence and practice, which, the authors argue, is conceptually under‐developed. The paper aims to show that current research perspectives fail to frame evidence and policy in relation to practice.

A qualitative study was conducted in the English NHS in four Primary Care Trusts (PCTs). Seventy‐five observations of meetings and 52 semi‐structured interviews were completed. The approach to data analysis was to explore and reconstruct narratives of PCT managers' real practices.

The exploratory findings are presented through two kinds of narratives. The first narrative vividly illustrates the significance of the active involvement, skills and creativity of health care practitioners for policy implementation. The second narrative elucidates how problems of collaboration among different experts in PCTs might emerge and affect evidence utilisation in practice.

The findings exemplify that policies are made workable in practice and, hence, policy makers may also need to be mindful of practical intricacies and conceive policy implementation as an iterative process.

The contribution of this paper lies in offering an alternative and important perspective to the debate of utilisation of policy/evidence in health care management and in advancing existing understanding of health care management practice. The paper's rich empirical examples demonstrate some important dimensions of the complexity of practice.