Unlocking the doors: introducing practice development to Canadian healthcare

Abstract

From my early days as a nursing assistant in complex continuing care, I recognised that all was not well in healthcare. I was particularly troubled with practices that I perceived to be antithetical to ‘caring’ and I struggled to facilitate change within my very limited circle of influence. I remember well the day I asked for the key to open the balcony doors on the unit so I could take patients out for a breath of fresh air. Being told by the registered nurse that ‘those doors haven’t been opened in 15 years and that isn’t going to change’, was what I now appreciate as the start of my practice development journey. Although I have had the privilege of observing and contributing to more quality healthcare practices in my subsequent roles as a registered nurse, advanced practice nurse and, most recently, Director of Interprofessional Practice, I am also keen to know how far we have yet to go in bringing that ‘fresh air’ I sought decades ago to our patients through more person centred means. I think our lack of progress can be attributed in part to evolving technologies in healthcare that pull our attention away from the human-to-human exchange that has the most impact on patients’ experience of care. Practice development holds the promise of keeping us focused on our caring practices, in balance with the seductive lure of high tech solutions, to address gaps in our quality care. Canada is not alone in its need of healthcare improvement; media and scholarly literature across the globe abound with examples of poor quality care and calls to action across healthcare sectors, settings and specialties. Canada is, however, distinct because of the absence of practice development as a systematically adopted methodology for meeting quality improvement priorities at provincial, national or even local levels. This is despite how embedded practice development has become at local and national levels in both practice and academic settings beyond North America, with examples including the Older Persons Services National Practice Development Programme in the Republic of Ireland, the New South Wales-based Essentials of Care programme in Australia and the England Centre for Practice Development hosted by Canterbury Christ Church University. These success stories, as well as the breadth of related theoretical and empirical literature that has evolved over the past 20 years, have not influenced Canadian healthcare practices much beyond the level of individual academics and practitioners – a relatively small group of converts.