Feature
NURSING MANAGEMENT April 2009 | Volume 16 | Number 1 27
lord Darzi describes three roles for front line
clinical staff:
as practitioners, who deliver good care to patients
and clients, and to their families and carers.
as partners, who work closely with others in
healthcare, education and social services to
integrate care based on the individual needs
of patients and clients.
as leaders, who take responsibility for leading
change and development.
His report makes clear that the nHs will enable
front line providers and commissioners to use their
expertise, creativity and skills to find new ways to
improve care for patients. this aspiration is shared
by teams that are effective at practice development.
lord Darzi's report also recommends that,
to improve services for patients in line with
national service frameworks, clinicians should be able
to adopt the roles of practitioner, partner or leader.
Visions for improvement
teams that are adept at practice development take
a systematic and co-ordinated view of their work
(mcsherry 2008). they take time to identify what
they are good at, produce the evidence to prove it
and put frameworks in place to guide developments.
However, lack of time can prevent clinical teams
from asking questions about the quality of care that
they provide and so it should be remembered that
high levels of activity do not necessarily mean high
standards of care.
For clinical teams to succeed in practice
development, their members must share a vision of
how healthcare practice will be improved for patients
and clients (Boomer et al 2008).
each region of the nHs in england has published
its own vision for such improvements (DH 2008b),
and teams should try to ensure that their visions
for improvement and those of the nHs are the same.
teams must be aware of the opportunities
and challenges presented by the external world,
including political and economic influences, and the
prevailing social and technological circumstances.
to be effective, practice development teams
must examine their strengths and weaknesses
carefully and review the available internal resources,
particularly the knowledge, skills and attributes of
team members and wider organisations.
this is important because practice development
requires organisational collaboration and support to
bring about change and embed new ways of working
in practice (Kitson et al 1996, Wallace et al 2001,
Ward et al 1998).
Once teams have established where they are,
the resources that are available, and the new
Box 4 An assessment of practice development
Teams can measure their success in practice development by calculating a score
between one and five for how much each of the following statements is true of
them or their work, in which one represents `never' and five represents `always'.
The scores teams give themselves can guide them in choosing areas of practice
to improve. Where individual scores are of two or less, immediate action is
required; where they are of three, action is required in the short to medium
term. Teams whose scores are mostly fours or fives are the most effective at
practice development.
1. The team has a clear vision of the future of its practice.
2. The team systematically prioritises developments, based on the needs
of service users.
3. Feedback from service users and carers is used to reflect and to identify areas
for development or improvement.
4. Service users are informed of changes to practice made as a result of their
comments or suggestions.
5. The ideas of support staff are valued as highly as those of senior practitioners.
6. The team involves service users and carers in developing practice.
7. The team seeks help from people in the organisation who are not
team members.
8. Team members can read published evidence critically.
9. Team members are given opportunities to discuss published evidence
of practice development.
10. Team members monitor and review each other's work.
11. Team members are skilled at finding research evidence.
12. The team works with university colleagues to develop practice and
generate theories.
13. The team refers to the relevant literature when developing practice.
14. Team members are encouraged to reflect on practice.
15. The team has evidence to prove that its practice is based on the best
available knowledge.
16. Team meetings provide opportunities for members to critically review
and learn from practice.
17. The team refers to clinical audits to identify areas for practice development.
18. The team evaluates changes to practice systematically.
19. Team members can share new ideas regularly.
20. The team receives new ideas for practice with enthusiasm.
21. The team actively supports new ideas for practice development.
22. Team members work closely with their managers to develop practice.
23. Developments in practice involve multidisciplinary teams.
24. Team members communicate regularly with other practitioners to share
information and ideas.
25. Team members are actively engaged in self-development for the benefit
of service users.
26. The development of individual team members is relevant to the team's vision
and objectives.
27. When team members go to study events or visit other units, they always
report back to the rest of the team.
28. The team routinely informs other teams about its developments.
29. The team routinely networks with other units.
This assessment should be undertaken annually to check for changes in team
effectiveness in each area.

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