Feature
NURSING MANAGEMENTApril 2009 | Volume 16 | Number 124
Practice development in
healthcare service reform
Helen Chin and Ben Totterdell explain how front line healthcare professionals
in clinical teams can control the development and improvement of
local healthcare services by taking a practice development approach
HealtH minister lord Darzi, the author of the
nHs next stage review final report (Department of
Health (DH) 2008a), is a surgeon working in the nHs
and his report is based on personal consultations
with about 2,000 clinicians and patients.
this background has made the report credible
among healthcare professionals, who perceived that
its author understood the complexities and realities
of health care on the front line.
such credibility is lacking, however, in some
earlier service initiatives, which have been
unsuccessful at clinical level in large part because
they were not led by healthcare professionals
working at the point of care, who are best placed to
influence and initiate quality improvements (Page
and Hamer 2002, Porter-O'Grady and Wilson 1995).
the Darzi report explicitly offers clinical teams
the `freedom to focus on quality' by putting them in
control of their own developments (DH 2008a).
such a move away from a top-down,
one-size-fits-all approach offers clinicians at all
levels opportunities to lead improvements in care
and to determine new ways of working.
the report presents front line healthcare
professionals not only with opportunities, but
with some unique challenges (Box 1) that they can
overcome by developing their practice.
What Lord Darzi says
lord Darzi suggests that `quality should be at
the heart of everything we do', and identifies
four elements of good care:
Helping people stay healthy.
empowering patients.
Providing the most effective treatments.
Keeping patients as safe as possible.
to help people to stay healthy the nHs must
focus on preventing ill health, and must work
with other agencies to ensure that people
have access to prevention services and can
call on the expertise of the appropriate
healthcare professionals.
empowering patients involves offering them
greater choice over where, when and from whom
they obtain their health care.
to ensure that they can exercise these choices,
they must also be given better information about the
types and locations of available services. in addition,
healthcare professionals and organisations should
instil confidence in patients through the publication
of easily understood outcome data.
in preferring care from teams that demonstrate
their use of best practice, patients begin to exercise
control over the services they receive. thus, patients'
opinions about the quality of their care affect the
level of annual income of healthcare organisations.
summary
This article examines the proposals contained in
health minister Lord Darzi's Next Stage Review
final report and considers how clinical teams
can implement them in their everyday practice.
While the article acknowledges that clinical teams
may already meet many of the recommendations
in the review, some may have insufficient evidence
to prove that they have, or are not yet working
systematically enough to ensure consistently high
standards of practice. The article provides teams
with approaches and tools that enable effective
developments in practice.
Keywords
Practice development, empowerment, effectiveness

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