Unravelling the consequence of practice development: an exploration of the experiences of healthcare practitioners

摘要

Background: The strong focus on achieving quality, improvement and efficiency in the United Kingdom’s NHS is driven extensively by the policies of both the previous and current governments. However, achieving quality and maintaining improvement alongside substantial reduction in resources is a ‘tall order’. Practice development has emerged and become refined as an activity focused on developing people and practice for the ultimate purpose of achieving high quality, person-centred care. How practice development achieves this remains a less explored area, alongside the outcomes for practice. This papers draws from the findings of an original research study that explored practice development, the approaches used and the influence it has on the experience of practitioners and their clinical practice in order to share some new perspectives on activities that enable more person-centred healthcare, practice improvement and innovation. Aims and objectives: The original research involved participants from two practice development projects in separate NHS hospital trusts. The use of a flexible ‘generic’ descriptive qualitative design, using within-method data triangulation, combining focus groups, narratives, retrospective documentary analysis and field notes, enabled exploration and presentation of practitioners’ experiences of practice development in the ‘real-world’ of practice. Results: Thematic data analysis revealed that the experience of practice development varies but is characterised by frustration and achievement, an increase in workload but also in effectiveness, and a greater focus on teamwork. From further examination of the data drawing on a concept analysis framework, two typologies emerged representing activity that takes place in practice to develop and improve healthcare. One is service improvement – a means of establishing new healthcare services and/or improving existing ones; the other is emancipatory practice development, which is a process for achieving change characterised by the values of person-centeredness, partnership, enabling, active learning, evaluation and ultimately culture transformation. Conclusions: The work contributes to understanding of the ‘practice’ of practice development as a methodology for enabling high quality, person-centred care. It also provides a more positive stance and way forward for ongoing activities associated with improving healthcare; namely, service improvement in the UK NHS.