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

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: Enable a continuous process of improvement designated to promote increased effectiveness in person centred care. 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. 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 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): Phase 1: Phase 1: Identify key priorities for PD in line with the new model for service delivery 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: Phase 3: Implement the strategy for PD Implement the strategy for PD

‘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

Improving patient care Learning in and from practice Systematic approaches

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 potential. Enable older people to achieve their optimum potential. Provide evidence based time-limited rehabilitation. Provide evidence based time-limited rehabilitation. Develop work base cultures. Develop work base cultures. Establish flexible teams & working. Establish flexible teams & working. Contribute to the PCT’s strategic direction & clinical governance. Contribute to the PCT’s strategic direction & clinical governance.

Example of possible PD projects within the Strategy: Sustaining a shared PD & IC Vision Sustaining a shared PD & IC Vision Transformational Leadership Transformational Leadership Fundamentals of time limited rehabilitation Fundamentals of time limited rehabilitation Working with service users & their agendas Working with service users & their agendas Interdisciplinary team work Interdisciplinary team work

Achievements… We have a PD Strategy! We have a PD Strategy! Raising the profile and focus of PD Raising the profile and focus of PD Development of PD Strategy Champions who are questioning practice within their teams & challenging the culture 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 How we talk about and refer to older people Reviewing the process of care planning Reviewing the process of care planning Developing the use of patient stories to evaluate care Developing the use of patient stories to evaluate care Using PD to underpin practice/ service development Using PD to underpin practice/ service development

Reflections….

Being part of the journey has been both exciting and challenging Being part of the journey has been both exciting and challenging External facilitation was key External facilitation was key Understanding the culture Understanding the culture Skills needed to manage challenges: 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!’ Maintaining momentum & a vision – ‘we’ve been there before!’ Skills needed to facilitate, enable & support Skills needed to facilitate, enable & support Seeing changes…practitioners & practice Seeing changes…practitioners & practice

‘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!’ ‘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: Moving from technical PD towards emancipatory PD 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

Improving patient care Learning in and from practice Systematic approaches