Feature
NURSING MANAGEMENTApril 2009 | Volume 16 | Number 126
the advent of a new policy is usually followed by
a host of initiatives, directives and work programmes
designed to ensure its implementation.
although this process can give the impression
that new work is required, many quality standards
and initiatives are possibly being met or exceeded
by existing practices already. For example, clinical
teams implementing lord Darzi's proposals may not
have devised frameworks that can systematically
and coherently link the results of their work.
to identify practice development topics, clinical
teams should gather all the available information on
a specific aspect of their practice and identify what
they still need to know.
Box 3 Characteristics of teams that demonstrate effective practice development
A clear vision of what must be achieved.
A passion for learning and reflecting.
An unrelenting focus of all staff training and
development activities on the needs of patients.
Curiosity and creativity among team members.
An effective leadership of teams.
A systematic framework developed in partnership
with patients and others.
An ability to recognise when teams reach
their goals.
An ability to innovate when finding solutions to
patient-centred problems.
Effective links with higher education institutions
so that students encounter no mismatch between
theory and practice
An ability to ensure that the evidence base
of practice is sound so that decisions can
be rationalised.
A system to evaluate the effects of developments
on patients and clients, teams and organisations.
An inclusive approach that values the ideas of all
team members.
A high level of accountability by which
developments are shared among colleagues outside
teams to ensure that good practice is spread and
less successful experiences are identified.
A good relationship with, and accountability to, senior
management to ensure support, best use of resources,
links to organisational strategies and government
policies, and accelerated decision making.
Box 2 Questions to ask when identifying practice development topics
Has this form of practice development been undertaken before or is it being
undertaken now?
Is there published evidence on the topic under consideration?
If this form of practice development is new, how will service users, staff and
the organisation benefit from its results?
Are its objectives specific, measurable, achievable, realistic and timely (SMART)?
Whose authority is needed for it and whose opinions are needed about it?
What resources, support, knowledge and skills are needed?
How much time is needed?
How should it be started?
Who will take the lead?
Does it involve any risk?
How can its effects on practice be measured?
Can it be piloted and, if so, how and when will the pilot be evaluated?
If the pilot is successful, who will decide if it should be introduced elsewhere?
What form will the results take and how will they be collected?
Who should be informed of the results and how will they be disseminated?
Will the format of the results be tailored to people's differing needs?
How will the results be evaluated?
Has the practice development highlighted a need to examine other issues?
they should then ask themselves the questions
listed in Box 2.
many healthcare professionals will have said,
or will have heard colleagues say, that healthcare
services can be improved if specific courses of
action are taken. a key task for nurse managers,
therefore, is to ensure that practice development
ideas, from staff at all levels, can be implemented,
evaluated and shared.
Practice development
according to Page and Hamer (2002), all clinical staff
involved in practice development should function
as teams, and these should ensure that the needs of
patients are at the centre of everything they undertake.
they say that practice development is: `a discipline
focused on the improvement of care for patients in
the complex environment of real practice settings,
underpinned by the active engagement of practitioners,
often in partnerships with others.'
Page and Hamer (2002) add that practice
development draws on a range of theoretical
disciplines and practical approaches.
it is important to note that, while the terms
`practice development' and `service improvement'
are often used interchangeably, their meanings are
different. Practice development is a team-oriented
activity that is directly concerned with improving
care at the point of delivery, while service
improvement is focused on wider organisational
issues (mcsherry 2008). as well as being
evidence-based, innovative and of high quality,
examples of effective practice development have
several things in common (Box 3).
teams can measure the effectiveness of their
practice development using the assessment
described in Box 4.

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