Growing a practice development Growing a practice development strategy for Community Hospitalsstrategy for Community Hospitals

Jan DewingJan Dewing

Independent Nurse Consultant & Associate Independent Nurse Consultant & Associate Practice Development Fellow, RCNPractice Development Fellow, RCN

Jonathan WebsterJonathan Webster

Consultant Nurse, Older People, University Consultant Nurse, Older People, University College London Hospitals NHS Foundation Trust College London Hospitals NHS Foundation Trust

& Associate Practice Development & & Associate Practice Development & Gerontological Nursing Fellow, RCNGerontological Nursing Fellow, RCN

Background:Background:

Review of three Community HospitalsReview of three Community Hospitals Key drivers:Key drivers:

– National modernisation & reform agendaNational modernisation & reform agenda– Local drivers – practice & serviceLocal drivers – practice & service

Outcome – greater nurse & therapy led careOutcome – greater nurse & therapy led care Four work streamsFour work streams

Aim:Aim:

To develop a strategy for practice To develop a strategy for practice development across the three development across the three community hospitals that will underpin community hospitals that will underpin the development of expert person the development of expert person centred care in line with the new centred care in line with the new model for service deliverymodel for service delivery

Objectives:Objectives:

Enable a continuous process of improvement Enable a continuous process of improvement designated to promote increased effectiveness in designated to promote increased effectiveness in person centred care.person centred care.

Enable healthcare teams to develop their Enable healthcare teams to develop their knowledge and skills and in doing so transform the knowledge and skills and in doing so transform the culture and context of care.culture and context of care.

Support a systematic, rigorous and continuous Support a systematic, rigorous and continuous process of change that will free practitioners to act process of change that will free practitioners to act in new ways that better reflect the perspectives of in new ways that better reflect the perspectives of both services users and providersboth services users and providers

Stages of development Stages of development (the journey):(the journey):

Phase 1:Phase 1:

Identify key priorities for PD in line with the new Identify key priorities for PD in line with the new model for service deliverymodel for service delivery

Phase 2:

Agree and design a strategy to underpin PDAgree and design a strategy to underpin PD

Phase 3:Phase 3:

Implement the strategy for PDImplement the strategy for PD

‘‘Practice development is a continuous process of Practice development is a continuous process of improvement towards increased effectiveness in improvement towards increased effectiveness in patient centred care. This is brought about by patient centred care. This is brought about by helping healthcare teams to develop their helping healthcare teams to develop their knowledge and skills and to transform the culture knowledge and skills and to transform the culture and context of care. It is enabled and supported by and context of care. It is enabled and supported by facilitators committed to systematic, rigorous facilitators committed to systematic, rigorous continuous processes of emancipatory change continuous processes of emancipatory change that reflects the perspectives of service users.’that reflects the perspectives of service users.’

Garbett & McCormack, 2002Garbett & McCormack, 2002

Improving patient care

Learning in

and from

practi

ce

Systematic

approaches

The PD Strategy aimed to:The PD Strategy aimed to:

Enable proactive ‘step up’ & ‘step down’ IC.Enable proactive ‘step up’ & ‘step down’ IC. Enable older people to achieve their optimum Enable older people to achieve their optimum

potential.potential. Provide evidence based time-limited Provide evidence based time-limited

rehabilitation.rehabilitation. Develop work base cultures.Develop work base cultures. Establish flexible teams & working.Establish flexible teams & working. Contribute to the PCT’s strategic direction & Contribute to the PCT’s strategic direction &

clinical governance.clinical governance.

Example of possible PD projects Example of possible PD projects within the Strategy:within the Strategy:

Sustaining a shared PD & IC VisionSustaining a shared PD & IC Vision Transformational LeadershipTransformational Leadership Fundamentals of time limited rehabilitationFundamentals of time limited rehabilitation Working with service users & their agendasWorking with service users & their agendas Interdisciplinary team workInterdisciplinary team work

Achievements…Achievements…

We have a PD Strategy!We have a PD Strategy! Raising the profile and focus of PDRaising the profile and focus of PD Development of PD Strategy Champions who are Development of PD Strategy Champions who are

questioning practice within their teams & challenging questioning practice within their teams & challenging the culturethe culture

Examples: How we talk about and refer to older peopleHow we talk about and refer to older people Reviewing the process of care planningReviewing the process of care planning Developing the use of patient stories to evaluate careDeveloping the use of patient stories to evaluate care Using PD to underpin practice/ service developmentUsing PD to underpin practice/ service development

Reflections….Reflections….

Being part of the journey has been both exciting and Being part of the journey has been both exciting and challengingchallenging

External facilitation was keyExternal facilitation was key Understanding the cultureUnderstanding the culture Skills needed to manage challenges:Skills needed to manage challenges:

Engagement & involvementEngagement & involvementPotential for sabotagePotential for sabotageHelping people understand…Helping people understand…Technical vs emancipatory PDTechnical vs emancipatory PD

Maintaining momentum & a vision – ‘Maintaining momentum & a vision – ‘we’ve been we’ve been there before!’there before!’

Skills needed to facilitate, enable & support Skills needed to facilitate, enable & support Seeing changes…practitioners & practiceSeeing changes…practitioners & practice

‘‘Since we started this work I think there has Since we started this work I think there has been a big difference because staff have been a big difference because staff have stopped seeing patients as being purely old, stopped seeing patients as being purely old, instead they see a person who has a past, instead they see a person who has a past, they have had different experiences, the they have had different experiences, the interaction is incredible…it’s made me realise interaction is incredible…it’s made me realise that the boundaries aren’t really there, you that the boundaries aren’t really there, you make the boundaries, you can do it!’make the boundaries, you can do it!’

Participant

Summary:Summary:

Moving from technical PD towards emancipatory PDMoving from technical PD towards emancipatory PD– Right at the beginning as part of strategy workRight at the beginning as part of strategy work– Include critical reflectionInclude critical reflection– learninglearning– skills developmentskills development– coaching for internal facilitatorcoaching for internal facilitator

Improving patient care

Learning in

and from

practi

ce

Systematic

approaches