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Preventing ‘Francis II’ – using practice development for culture change. Professor Brendan McCormack Director, Institute of Nursing & Health Research and Head of the Person-centred Practice Research Centre, University of Ulster. Professor II, Buskerud University College, Drammen, Norway;
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Professor Brendan McCormack
Director, Institute of Nursing & Health Research and Head of the Person-centred Practice Research Centre, University of Ulster.
Professor II, Buskerud University College, Drammen, Norway;
Adjunct Professor of Nursing, University of Technology, Sydney;
Visiting Professor, School of Medicine & Dentistry, University of Aberdeen.
“… I don't think the <service name> nurses I encountered were uncaring. They were ill prepared for the tasks they faced, sometimes insensitive, unsupported by the structures and ethos of the service and very overwhelmed, but I wouldn't say they didn't care or that they didn't, for the most part, work hard. They reminded me of the adage 'the road to hell is paved with good intentions' and even if they had known more … or at least
have been aware of what they didn't know, they still couldn't have functioned adequately within the structures and systems”
[‘Prof Faith Gibson, 16th October 2011].
“The Trust’s culture was one of self promotion rather than critical analysis and openness. This can be seen from the way the Trust approached its FT application, its approach to high Hospital Standardised Mortality Ratios (HSMRs) and its inaccurate self declaration of its own performance. It took false assurance from good news, and yet tolerated or sought to explain away bad news”.
“It cannot be suggested that all these characteristics are present everywhere in the system all of the time, far from it, but their existence anywhere means that there is an insufficiently shared positive culture”.
“To achieve <a change in culture> does not require radical reorganisation but re-emphasis of what is truly important:
“Person-centeredness is an approach to practice established through the formation and fostering of healthful relationships between all care providers, service users and others significant to them in their lives. It is underpinned by values of respect for persons, individual right to self determination, mutual respect and understanding.
It is enabled by cultures of empowerment that foster continuous approaches to practice development”.
(McCormack & McCance 2010)
Practice development is a continuous process of developing person-centred cultures. It is enabled by facilitators who authentically engage with individuals and teams to blend personal qualities and creative imagination with practice skills and practice wisdom. The learning that occurs brings about transformations of individual and team practices. This is sustained by embedding both processes and outcomes in corporate strategy. (McCormack, Manley & Wilson, 2009)
Shared Values and Vision
transforming individuals and contexts of care
(adapted from McCormack & Garbett, 2004)
“The constant tussle between conflicting priorities … and the desire to live out person-centred values in practice was evident from the data … while acknowledging that everyday practice is challenging, often stressful, sometimes chaotic and largely unpredictable, it is important to ask how we can ensure person-centredness becomes an everyday cultural norm.”
(McCance et al 2013)