Feature
NURSING MANAGEMENTApril 2009 | Volume 16 | Number 128
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Helen Chin is director of
practice development and
Ben Totterdell is a programme
associate, both at the Centre
for the Development of
Healthcare Policy and Practice,
University of Leeds
knowledge and skills they are likely to need, they can
plan development activities.
Practice development is not a licence for
innovation without accountability and, although
the process can be liberating and energising,
all developments must have measurable benefits
for patients, and must be in line with the overall
direction of individual nHs organisations.
it is also necessary for teams undertaking
practice development to be able to describe the
effects of their work on their organisations,
as well as on patients, so that initiatives can be
implemented elsewhere.
to demonstrate the effects of their work, clinical
teams must evaluate the outcomes of practice
development (attree 2001, Carr 2005, Clayton 2001,
maynard 2003).
some of these outcomes may be unintended.
For example, according to a clinical team at
high-security ashworth Hospital, part of mersey Care
nHs trust, one year after a programme of exercise and
healthy eating had been introduced patients' nutrition
had improved, the number of violent incidents had
declined and the use of `as necessary' drugs such as
sedatives had fallen by more than 70 per cent.
Other outcomes involve changes to processes or
the use of equipment. according to a clinical team
at Calderdale and Huddersfield nHs Foundation
trust, for instance, nurses who spent a night being
monitored in intensive care found the expensive
pressure-relieving beds uncomfortable and the units
overly noisy and bright.
as a result, the team invested in quiet-close bins
and silent telephones, and staff spoke more quietly at
night. they also bought ear plugs and eye masks for
patients, and used `ordinary' hospital mattresses as
often as possible.
the team is now studying whether, as a result
of these measures, cost savings have been made
because patients spend less time in intensive care,
a result that would gain the attention of the trust's
board and commissioners.
the Darzi report has offered clinical teams
opportunities to take local action to improve the care
they provide, rather than have changes imposed on
them. such a practice development approach enables
teams to take these opportunities systematically,
by taking stock of what they already do well and
planning improvements where necessary.
Practice development encourages teams to
consider and implement the best available evidence,
evaluate and disseminate their practice, and work
with higher education staff to ensure that new
knowledge reinforces, or is incorporated into,
practice more readily.
above all, it is explicitly focused on patients
and has the clear intention of improving quality
of care and services, a theme that lies at the heart
of lord Darzi's reforms.
References
implications for practice
By adopting a systematic, purposeful and sustainable
approach to improve practice, multidisciplinary
clinical teams can not only ensure that the health
care they provide is of the highest standard, but can
also ensure that they control their own development.

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