Transforming the NHS through transforming ourselves

Abstract Background: Leadership development impacts on quality of care and workplace cultures for staff. Clinical Leadership embracing transformational and other collective leadership approaches are key enablers to developing effective workplace cultures at the micro-systems level. Following the development of a shared purpose and values framework, an internal, inter-professional clinical leadership programme was set up to grow a critical community of transformational leaders across one NHS organisation in England. This programme had previously been unsuccessful in engaging medical doctors. Aims and Objectives: This paper shares how a dedicated practice development based clinical leadership programme set out to support medical doctors across one organisation with their leadership journey, equipping them to become both transformational and collective leaders and facilitators with the skills to begin to develop and sustain effective workplace cultures, that are person centred, safe and effective. Methods: Practice development methodology with its collaborative, inclusive and participative approach for developing person centred cultures combined with clinical leadership strategies, formed the basis of the programme which emphasised the use of active and action learning drawing on the workplace as the main resource for learning, development and improvement. Self-assessment and co-creation of insights about clinical leadership together with collaborative analysis of evaluation data led to the syntheses of insights through the use of reflection and action planning. Findings/Results: Findings are presented at two levels: 1) Five individual authentic reflections by authors to illustrate their leadership journeys which also demonstrate how a range of tools were used and their impact from reflections. Insights and learning include recognition of the benefits of peer support and networking; development of a disciplined approach to learning and self-management; 2) A collaborative reflection and critique that embraced the feeling of a sense of team ethos and community cohesion, for the first time in a safe environment; as well as, a sense of collective shared purpose and values. Conclusions: We conclude that the programme helped to identify the impact of leadership on workplace cultures and to begin to embed ways of working that are collaborative, inclusive, participative and celebratory. This unique approach by one organisation to leadership development has enabled a journey of self-transformation for medical clinical leaders to commence. Practical implications arising from our learning: • An internal model grows clinical leadership capacity across the organisation through peer support and networking and collective leadership. • Investing in a safe confidential space for clinical leads and other staff groups is a strategy for leadership development practice. • There is need to develop more skilled critical companions to support leadership, improvement and development activities • Clinical leadership development, informed by practice development methodology, demonstrates potential for enabling transformative and collective leadership for achieving person-centred cultures in the workplace. Keywords: Clinical leadership, collective leadership, critical companionship, micro-systems, transformational leadership, workplace cultur

Enhancing professionalism in education through inquiry learning: a living theory research approach

Here we present a rationale for enhancing professionalism through Living Theory research drawing on the accounts of practicing teachers to provide examples of evidence-based explanations of educational influences in learning. This rationale has emerged in the course of researching and answering questions of the kind ‘How do I improve what I am doing in my professional practice?’ and generating living-educational-theories (Whitehead, 1989) as valid explanations of our educational influences in our own learning, in the learning of others and in the learning of others with values that carry hope for the flourishing of humanity. We show how teachers are able to realize in practice two responsibilities they have as professional educational practitioners. The first is to continually inquire into their practice to understand, explain and improve it. The second is to create and make public valid accounts of their educational influences in learning as contributions to the development of an educational knowledge-base

Person-centredness - The ‘state’ of the art

Background: Person-centred practice is now firmly embedded in the nursing and healthcare discourse. While there is a growing body of development and research activity in the field, there is increased recognition of the need for further advances in the body of existing knowledge. This is reflected in the different approaches to person-centredness being adopted by healthcare systems internationally. Aims: To provide an overview of person-centredness and ways in which person-centred practice has been adopted in healthcare systems internationally. Methods: A summary review of the evidence underpinning the concepts and theory of person-centredness, incorporating an overview of national strategic frameworks that influence the development of person-centred practice in different countries. Findings: While there have been considerable advances in the development of person-centredness, there is a lot of work to be done in the adoption of more consistent approaches to its development and evaluation. In particular, a shared discourse and measurement tools are needed. Internationally, person-centredness is gaining momentum and many countries have strategic frameworks in place to direct its development and implementation

Overcoming synecdoche: why practice development and quality improvement approaches should be better integrated

Commentary on: Lavery, G. (2016) Quality improvement – rival or ally of practice development? International Practice Development Journal. Vol. 6. No. 1. Article 1

Technologies of birth and models of midwifery care

This article is based on a study of a reform in the organisation of maternity services in the United Kingdom, which aimed towards developing a more woman-centred model of care. After decades of fragmentation and depersonalisation of care, associated with the shift of birth to a hospital setting, pressure by midwives and mothers prompted government review and a relatively radical turnaround in policy. However, the emergent model of care has been profoundly influenced by concepts and technologies of monitoring. The use of such technologies as ultrasound scans, electronic foetal monitoring and oxytocic augmentation of labour, generally supported by epidural anaesthesia for pain relief, have accompanied the development of a particular ecological model of birth – often called active management –, which is oriented towards the idea of an obstetric norm. Drawing on analysis of women’s narrative accounts of labour and birth, this article discusses the impact on women’s embodiment in birth, and the sources of information they use about the status of their own bodies, their labour and that of the child. It also illustrates how the impact on women’s experiences of birth may be mediated by a relational model of support, through the provision of caseload midwifery care

Biographical learning: a process for promoting person-centredness in nursing

Background: This paper explores biographical approaches to nurses’ learning. It builds on previous PhD research to consider the effects of such approaches, drawing on the experiences of learners who have recently completed biographical study, in their own words. Aims and objectives: The aim of the paper is to make sense of different forms of learning. The objectives are to identify how autobiographical approaches that involve people learning from their life stories can engage people to exert agency, or ownership, in their own lives by taking control of their learning plans. Design: This longitudinal study started with the first group of learners undertaking a biographical preparation module on an Applied BSc Health and Social Care programme. Methods: Research relating to nurses’ learning is considered, including a Swiss perspective, as well as the validity of the biographical approach to developing knowledge. The learners share stories of their learning in order to develop understanding and new insights into their own lives and those of others. Results: Different dimensions of learning including learning about self, learning to make a difference and processes of repair are revealed through the learners’ narrations. Conclusions: Engaging biographically, to make sense of different forms of learning, appears to be beneficial to more person-centred working. Implications for practice: •Introducing biographical elements into courses of study can benefit learners by helping them to make sense of who they are as learners and practitioners •Co-creating compelling spaces of learning can facilitate learners to exert agency within their own lives as well as help others to learn. By exerting agency we mean taking ownership of the learning revealed through the biographical work and taking it forward in positive ways to enhance person-centred care

Insights of private general practitioners in group practice on the introduction of National Health Insurance in South Africa

Background: The South African government intends to contract with ‘accredited provider groups’ for capitated primary care under National Health Insurance (NHI). South African solo general practitioners (GPs) are unhappy with group practice. There is no clarity on the views of GPs in group practice on contracting to the NHI. Objectives: To describe the demographic and practice profile of GPs in group practice in South Africa, and evaluate their views on NHI, compared to solo GPs. Methods: This was a descriptive survey. The population of 8721 private GPs in South Africa with emails available were emailed an online questionnaire. Descriptive statistical analyses and thematic content analysis were conducted. Results: In all, 819 GPs responded (568 solo GPs and 251 GPs in groups). The results are focused on group GPs. GPs in groups have a different demographic practice profile compared to solo GPs. GPs in groups expected R4.86 million ($0.41 million) for a hypothetical NHI proposal of comprehensive primary healthcare (excluding medicines and investigations) to a practice population of 10 000 people. GPs planned a clinical team of 8 to 12 (including nurses) and 4 to 6 administrative staff. GPs in group practices saw three major risks: patient, organisational and government, with three related risk management strategies. Conclusions: GPs can competitively contract with NHI, although there are concerns. NHI contracting should not be limited to groups. All GPs embraced strong teamwork, including using nurses more effectively. This aligns well with the emergence of family medicine in Africa