Overcoming synecdoche: why practice development and quality improvement approaches should be better integrated

摘要

Commentary on: Lavery, G. (2016) Quality improvement – rival or ally of practice development? International Practice Development Journal . Vol. 6. No. 1. Article 15. ( https://www.fons.org/library/journal/volume6-issue1/article15 ) We are pleased to be provided with an opportunity to comment on the thoughtful article by Gavin Lavery about the relationship between practice development and quality improvement, published in 2016 in the IPDJ . We also respect and value the opportunity to bring different perspectives together – something alluded to in Lavery’s article when discussing the relationship between service improvement and quality improvement. We acknowledge Lavery’s humility and openness to different perspectives as demonstrated by his willingness to participate in a foundation practice development school. We also accept that there are many different ways of achieving the same outcomes, by using a range of tools flexibly based on shared and common principles, as well as knowing the people you work with and being clear about purpose. At a time of scant resources in healthcare, it is vital that we avoid duplication and integrate approaches if service users are to experience the continuity and seamlessness of a person-centred approach to meeting the health and social care needs of individuals and communities. Lavery makes reference to ‘systems and processes’. It is important when discussing systems that we have a sense of shared meaning, as systems comprise structures, processes and patterns of behaviour. It is often the latter that are most challenging to address when trying to develop practice and improve quality (McCormack et al., 2008). Patterns of behaviours are an important focus when engaging staff in learning and reflection. Helping practitioners to become self-aware about the consequences of their actions on others (enlightenment), particularly in relation to being person-centred, has a strong history in practice development, linked to using the workplace as the main resource for active learning (Dewing, 2008). While these insights have relevance for both practice development and quality improvement, it is the former, through its theoretical development, that has attended to these concepts intentionally. In practice development it has long been argued that structures and processes follow values and purposes and that these values also enable and guide decision making, not vice versa (Manley et al., 2011). Thus, liberating people from the bureaucracies of detailed processes and micromanagement may impact favourably on both practice development and quality improvement. This point enables us to emphasise that practice development is about co-creation of shared values and purposes, and it is these that guide direction and decision making linked to both the evidence base and the key principles of collaboration, inclusion and participation, shaping whether a workplace culture enables or inhibits person-centred practice. Often this collaboration and participation takes the form of collective reconnaissance about context that marks the beginning of systematic action spirals in the practice development journey (McCormack, Manley and Titchen, 2013).