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Growing a practice development strategy for Community Hospitals. Jan Dewing Independent Nurse Consultant & Associate Practice Development Fellow, RCN Jonathan Webster

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growing a practice development strategy for community hospitals

Growing a practice development strategy for Community Hospitals

Jan Dewing

Independent Nurse Consultant & Associate Practice Development Fellow, RCN

Jonathan Webster

Consultant Nurse, Older People, University College London Hospitals NHS Foundation Trust & Associate Practice Development & Gerontological Nursing Fellow, RCN

background
Background:
  • Review of three Community Hospitals
  • Key drivers:
    • National modernisation & reform agenda
    • Local drivers – practice & service
  • Outcome – greater nurse & therapy led care
  • Four work streams
slide3

Aim:

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

objectives
Objectives:
  • Enable a continuous process of improvement designated to promote increased effectiveness in person centred care.
  • Enable healthcare teams to develop their knowledge and skills and in doing so transform the culture and context of care.
  • Support a systematic, rigorous and continuous process of change that will free practitioners to act in new ways that better reflect the perspectives of both services users and providers
stages of development the journey
Stages of development (the journey):

Phase 1:

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

Phase 2:

Agree and design a strategy to underpin PD

Phase 3:

Implement the strategy for PD

slide6

‘Practice development is a continuous process of improvement towards increased effectiveness in patient centred care. This is brought about by helping healthcare teams to develop their knowledge and skills and to transform the culture and context of care. It is enabled and supported by facilitators committed to systematic, rigorous continuous processes of emancipatory change that reflects the perspectives of service users.’Garbett & McCormack, 2002

slide7

transforming individuals and contexts of care

Improving

patient care

Learning in

and from

practice

Systematic

approaches

Values and beliefs

the pd strategy aimed to
The PD Strategy aimed to:
  • Enable proactive ‘step up’ & ‘step down’ IC.
  • Enable older people to achieve their optimum potential.
  • Provide evidence based time-limited rehabilitation.
  • Develop work base cultures.
  • Establish flexible teams & working.
  • Contribute to the PCT’s strategic direction & clinical governance.
example of possible pd projects within the strategy
Example of possible PD projects within the Strategy:
  • Sustaining a shared PD & IC Vision
  • Transformational Leadership
  • Fundamentals of time limited rehabilitation
  • Working with service users & their agendas
  • Interdisciplinary team work
achievements
Achievements…
  • We have a PD Strategy!
  • Raising the profile and focus of PD
  • Development of PD Strategy Champions who are questioning practice within their teams & challenging the culture

Examples:

  • How we talk about and refer to older people
  • Reviewing the process of care planning
  • Developing the use of patient stories to evaluate care
  • Using PD to underpin practice/ service development
slide13
Being part of the journey has been both exciting and challenging
  • External facilitation was key
  • Understanding the culture
  • Skills needed to manage challenges:

Engagement & involvement

Potential for sabotage

Helping people understand…

Technical vs emancipatory PD

  • Maintaining momentum & a vision – ‘we’ve been there before!’
  • Skills needed to facilitate, enable & support
  • Seeing changes…practitioners & practice
slide14

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

summary
Summary:
  • Moving from technical PD towards emancipatory PD
    • Right at the beginning as part of strategy work
    • Include critical reflection
    • learning
    • skills development
    • coaching for internal facilitator
slide16

transforming individuals and contexts of care

Improving

patient care

Learning in

and from

practice

Systematic

approaches

Values and beliefs