Practice Development Methodology Research Articles

Fast-track and person-centred care in geriatric traumatology in a German-speaking Swiss hospital – A practice development project

IntroductionElderly persons have an increased risk for negative health-related outcomes, including higher mortality rates. A centre for geriatric traumatology was established in a German-speaking Swiss hospital to provide more specialised, person-centred care and to lower negative health outcomes. Adaptations and changes in the patient pathway were made by implementing fast-track and person-centred care to better address individual needs. MethodsThe current patient pathway was analysed by an interprofessional and interdisciplinary geriatric traumatology expert team. The practice development methodology and the Person-Centred Practice Framework (PCP-Framework) were used throughout this engagement process. In consensus within the expert team, the sample was defined as elderly persons aged 65 years or older with suspected hip joint closed fractures. The focus was on three elements of “practice environment” from the PCP-Framework. These were: (1) supportive organisational systems; (2) the physical environment; (3) appropriate skill mix. ResultsSeveral adaptations and changes were made addressing the three elements of “practice environment”. These were for example: (1) use of specific assessments, shared decision-making; (2) proper and effective use of aids; (3) integration of Advanced Practice Nurses. The adaptations in the patient pathway were integrated into the standard operating procedures. ConclusionsThrough active engagement with the practice development methodology and the focus on person-centredness, the process of care for elderly persons was adapted. Thus, by addressing individual needs, fast-track and person-centred care in geriatric traumatology is provided. Further research is needed to evaluate and to verify implications in clinical practice.

Co-creating system-wide improvement for people with traumatic brain injury across one integrated care system in the United Kingdom to initiate a transformation journey through co-production.

There is a need for better integration of services across communities and sectors for people living with traumatic brain injury (TBI) to meet their complex needs. Building on insights gained from earlier pilot work, here we report the outcomes of a participatory workshop that sought to better understand the challenges, barriers and opportunities that currently exist within the care pathway for survivors of TBI. A diverse range of stakeholders from the acute and rehabilitation care pathway and the health and social care system were invited to participate in a 3-hworkshop. The participants worked in four mixed subgroups using practice development methodology, which promotes person-centred, inclusive and participatory action. Thematic analysis identified shared purposes and values that were used to produce a detailed implementation and impact framework for application at both the level of the care interface and the overarching integrated care system. A variety of enablers were identified that related to collective values and behaviours, case management, team leadership and integrated team working, workforce capability, evidence-based practiceand resourcing. The clinical, economic, cultural and social outcomes associated with these enablers were also identified, and included patient safety, independence and well-being, reduced waiting times, re-admission rates, staff retention and professional development. The co-produced recommendations made within the implementation and impact framework described here provide a means by which the culture and delivery of health and social care services can be better tailored to meet the needs of people living with TBI. We believe that the recommendations will help shape the formation of new services as well as the development of existing ones. Patient and public involvement have been established over a 10-year history of relationship building through a joint forum and events involving three charities representing people with TBI, carers, family members, clinicians, service users, researchers and commissioners, culminating in a politically supported event that identified concerns about the needs of people following TBI. These relationships formed the foundation for the interactive workshop, the focus of this publication.

Growing the interprofessional workforce for integrated people-centred care through developing place-based learning cultures across the system

Background: The World Health Organization’s global strategy presents compelling evidence for the need to develop people-centred and integrated health services. However, there is a dearth of literature on learning at the macro-systems level focused on ‘place’ that is required to meet these ambitions. Aims: This article positions place-based learning at the heart of integrated care to contribute understanding of learning for transformation to inform continuous improvement and workforce development. Second, using practice development methodology, it demonstrates how to develop a shared understanding for place-based learning, sustained through a co-created implementation and impact framework. Methods: Five facilitated co-creation workshops with key stakeholders drew on participants’ collective knowledge, expertise and values to develop a shared understanding and direction. Collaborative themes arising from the workshops were used to populate a concept analysis framework for place-based learning, to identify its attributes, enablers and impacts. Findings: A shared purpose for and definition of place-based learning resulted, with three interdependent value themes: people-centred learning; cultures of teamwork to enable learning; and networks for learning together. Enablers, attributes and other factors were identified to support successful implementation and evaluation across one region in England. Conclusion: Place-based learning is a new concept previously undefined in the context of health education and integrated healthcare systems. The insights that emerged increase our understanding about how this concept can support local, national and global strategies, optimising the contribution of learning to integrated health and social care. Implications for practice: Integrated health and social care services need to: Grow a critical mass of skilled facilitators with the capabilities to integrate learning and improvement with other functions (such as embedded research) so as to develop systemwide Enable leaders to create learning cultures collectively with facilitators to increase understanding about the impact of culture on learning and improvement Develop indicators of the impact of learning across place

How nurses and midwives engage with patient experience data to inform person‐centred quality and safety improvements

To explore how nurses and midwives engage with patient experience data collected via a mobile health app to inform person-centred practice improvements. A large amount of data is collected in healthcare, yet there is limited evidence outlining how nursing and midwifery staff utilise patient experience data to inform person-centred quality and safety improvements. This study utilised action research, underpinned by Practice Development methodology and has been reported using the SQUIRE 2.0 checklist. Six clinical units (medical short stay, acute medical, surgical, oncology/haematology, day surgery and maternity) in a large health district in Australia engaged in three cycles of data collection using a mobile health app. The app captured patient experience data relating to the person-centred KPIs developed and tested by McCance et al. (2012). Staff used the data to develop and evaluate person-centred practice. A number of improvements in scores and practice occurred through engaging with the data in a cyclical way. All six clinical units saw an improvement in four or more of the KPIs in the patient survey results from cycle one to cycle three, with two clinical units improving in all eight. On average across the six units, there was also an increase in time nurses/midwives were visible to their patients, an increase in clinical documentation reflecting the patients' needs and what was important to them, an increase in positive comments and a decrease in negative comments in patient stories. This study shows that collecting and utilising data from the person-centred KPIs in a collaborative and cyclical way lead to enhanced patient experience and the development and implementation of person-centred quality and safety improvements. Capturing and utilising data that are meaningful to nursing/midwifery teams in a cyclical, action-orientated approach result in person-centred practice improvements that enhance the experience of those that are receiving and delivering patient care.

Change starts with me: an impact evaluation of a multiprofessional leadership programme to support primary care networks in the South East of England

PurposeThis paper aims to present the impact evaluation findings from a multiprofessional leadership programme commissioned in the South East of England to support primary care networks (PCNs) to lead system improvement together. It identifies programme impact at micro and meso system levels; a leadership impact continuum that can be used by individuals and teams to evidence impact of improvements in PCN practices; the learning and development strategies that were effective and proposes implications for other networks.Design/methodology/approachMixed methods underpinned by practice development methodology were used to explore the impact of the programme on two practitioner cohorts across 16 PCNs. Data were collected at the start, mid-point and end of the eight-month programme.FindingsResults illustrate an innovative approach to collective leadership development. A continuum of impact created with participants offers insight into the journey of transformation, recognising that “change starts with me”. The impact framework identifies enablers, attributes and consequences for measuring and leading change at micro, meso and macro levels of the health-care system. Participants learned how to facilitate change and collaboratively solve problems through peer consulting which created a safe space for individuals to discuss workplace issues and receive multiprofessional views through action learning. These activities enabled teams to present innovative projects to commissioners for service redesign, enabling their PCN to be more effective in meeting population health needs. The authors believe that this programme may provide a model for other PCNs England and other place-based care systems internationally.Originality/valueThis study offers insight into how to enable a journey of transformation for individuals and PCN teams to enhance team effectiveness and collective leadership for system-wide transformation required by the National Health Service Long Term Plan (2019).Contribution to Impact

Constructing a measure of balance recovery confidence for older persons: content themes from different stakeholders

Background: The absence of patient-reported outcome measures (PROMs) for a specific construct or target population suggests a need for such measures to be developed. A case in point is the domain of falls efficacy; a PROM for balance recovery confidence was proposed to improve older persons ’agency to arrest a fall. Appropriate participation in its development by relevant stakeholders was identified as essential to maximise the utility of the PROM and its potential to enhance patient care. There is a gap in the practice development literature in terms of PROMs for older persons. This article aims to encourage researchers to use the principles of practice development to address this gap by involving relevant stakeholders to gain greater insight. Methods: The nominal group technique and the Delphi technique were used to generate and refine the content of the measure, and content analysis was applied to assess and summarise the data. Findings: Unique themes emerged, such as ‘agency of older people in the prevention of falls ’from the community-dwelling older adults in Singapore, and ‘clinical specificity ’from an international panel of healthcare professionals. Common themes including ‘relevance to the target population’, ‘comprehensibility ’and ‘cultural and contextual sensitivity ’were found in both groups. Conclusion: A collaborative, inclusive and participatory approach involving different stakeholders, underpinned by practice development methodology, can offer rich insights for PROM developers. Implications for practice: Meaningful perspectives are generated from a diversity of views shared by representatives from all stakeholder groups involved in caregiving Participation of different stakeholders, such as physiotherapists, occupational therapists, nurses, doctors, podiatrists and older persons, provides a more robust and authentic approach to developing a PROM for older persons

Zwischen Traum und Trauma - Aufbau und Betrieb einer Kohortenstation für Patient_innen mit COVID-19 in einem Akutspital - Eine Fallstudie.

Description of the setting up of a cohort ward for patients with COVID-19 on a surgical ward including the development of the nursing team. The intrinsic retrospective case study describes the situation, identifies special phenomena in a reflective manner and links them to existing knowledge. Data were anecdotal, routine data were collected in the context of nursing practice development. Setting up the cohort ward in a Swiss hospital consisted of structural and technical planning, infection control measures, the establishment of interprofessional structures, and internal communication. During the four-week operation, 71 patients were treated. The use of practice development methodology initiated a cultural change. The reflection describes a field of tension between "dream and distress": As a dream, the lived experience of optimal care, with well-functioning processes, sufficient material, sufficient personnel and a very good interprofessional cooperation was evaluated. Distress in the form of high infection rates as well as psychological and physical stress did not occur. After the cohort ward was closed, there was a risk working back in normal operations based on existing economical and organizational conditions, with the knowledge that a different cooperation and organization is possible. Positive experiences from the "crisis mode" should be used to further develop essential operations during normal times.

Designing and implementing an electronic nursing record to support compassionate and person-centred nursing practice in an acute hospital using practice development processes.

The complexity of nursing practice can pose challenges to the development of an e-record that meets all the requirements and standards whilst capturing the essence of the relationship between the nurse and his/her patients. 1. Describe the process of designing the content of an electronic nursing record (e-record) specific to nursing in an Irish/UK context, using Practice Development (PD) methodology.2. To share the learning of involving the end-user in the development of a person-centred e-nursing record. Evidence-based PD methodologies, principles and evaluation tools were employed to involve end users in the development of a person-centred and evidence-based e-record. The results are limited to evaluation of the design process and reported using the SQUIRE guidelines for reporting quality improvement. Investing in time to involve end users in the design and implementation phase resulted in satisfaction and adoption of the e-record by nurses. For nurses to be satisfied with the content and process flow of an e-nursing record it needs to include the relational and non-clinical aspect of nursing practice in addition to the clinical pre-set content. Involving the end user in a meaningful way supports a positive outcome.

Improving sexual healthcare delivery for men in prison: A nurse-led initiative.

The study aim was to develop and evaluate a nurse-led sexual health service and health promotion intervention for men in prison. Men in prison are particularly marginalised members of our society, negatively impacting on their ability to making healthy choices. In relation to sexual health, prison provides an opportunity for curative and preventive care, for an otherwise often hard-to-reach, priority population. Practice development, audit and evaluation. Employing a practice development and participatory methodology, we empowered prison nursing staff to provide robust asymptomatic testing for sexually transmitted infections, including the management of chlamydia, with appropriate treatment and partner notification. Collaboratively with young men and nursing staff, a short animation video to promote the service was developed. A case note audit of 172 patients seen in the service during the 6-month period 1 July 2018-31 December 2018 was undertaken. The Standards for Quality Improvement Reporting Excellence (SQUIRE, see Supplementary Material) checklist was followed. National outcome measures were exceeded for some clinical outcomes. During the 6-month period, there were 12 chlamydia-positive (7% positivity rate) and 3 gonorrhoea-positive results. In addition, two new cases of syphilis were detected and a further two cases of known HIV were highlighted. There were seven cases of hepatitis C (3 previously diagnosed) and three cases of hepatitis B. A short animation Dick Loves Doot was developed. Successful partnerships between sexual health and prison healthcare services, in partnership with service users, can achieve well-coordinated services and health promotion interventions. This nurse-led model of care increased detection and early treatment of asymptomatic STIs among men in prison, impacting positively the men, their partner (s) and the public health of the society to which they return.

Leading the health service into the future: 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 culture

Arts-informed narrative inquiry as a practice development methodology in mental health

Arts-informed narrative inquiry as a practice development methodology in mental health

Exploring ‘self’ as a person-centred academic through critical creativity: a case study of educators in a school of nursing

Background: Developing person-centred cultures is a key focus of practice development. To do so requires engagement with learning approaches that are creative and critical. In preparing students for a future as person-centred practitioners, educators need to engage with creative approaches to the facilitation of learning. National standards in nursing (for example) as well as the international literature on adult learning endorse the need for creativity in learning. Yet, educators continue to be challenged to engage in creativity and to use creative learning strategies in their practice. This paper provides a reflective overview of the experiences of a group of educators in one school of nursing who participated in a programme of creative engagements that focused on exploring ‘self’ as a key concept in person-centredness. Objectives: 1. Explore through different media, contrasting aspects of ‘self’ as an educator 2. Engage in playful activity in a safe space to explore own creativity and ways in which this creativity could be surfaced and integrated into everyday practice 3. Through engaging with different media explore the potential of creativity in person-centred approaches to teaching, learning and research 4. Experience ‘risk taking’ in a facilitated environment in order to develop potential for meaningful connections with others – students and colleagues Conclusions: Through a systematic process of creative engagement, this critical reflection highlights the challenges associated with integrating creative engagement strategies in teaching and learning. The paper highlights in particular the challenges associated with ‘letting go’ in learning situations and the importance of exploring ‘self’ in the context of person-centred learning processes. Implications for practice: Practice development depends on effective facilitation undertaken by facilitators who are critical and creative. Whilst there is an increasing literature on facilitation models and processes, there is less attention paid to ‘understanding self’ as a facilitator of person-centred cultures. Practice development methodologies need to make such exploration an explicit part of their work in order to engage in authentic facilitation of learning and development.

Family-focused children’s end of life care in hospital and at home

An increasing number of children and young people require end of life care, and providing them and their families with optimum support at this time is crucial. This article describes how nurses working with children and families in home, hospital and community settings used the principles of practice development methodology to develop end of life care provision and follow-up bereavement support. It outlines the 'ways of knowing' that informed developments and how parents' priorities were kept central to the process. Finally, it discusses how the approach taken to practice development reflected the value of compassion in nursing practice.

A shared purpose framework to deliver person-centred, safe and effective care: organisational transformation using practice development methodology

Background: A shared purpose is an essential part of developing effective workplace cultures and one of the founding principles of practice development in establishing person-centred, safe and effective practices that enable everyone to flourish. Aims and objectives: The paper describes the aims of a piece of work first commissioned in 2011 (Phase 1) to review specialist practice – initially nursing and midwifery – across a large National Health Service trust in England. It then focuses on how this piece of work informed the development of a trustwide, shared purpose framework relevant to all staff, culminating in the strategies, processes and systems being used at individual, team and organisational levels to embed the framework, with the workplace as the main resource for learning. The challenges and successes along the way are highlighted. Methods: Practice development, a complex intervention, is used together with a strong partnership joint appointment model between the trust and the England Centre for Practice Development at Canterbury Christ Church University, to enable a transformational journey of cultural change across the organisation, starting with the creation of a shared purpose framework. Results: Examples from the trust’s workplace programmes are presented to demonstrate how the shared purpose and the skills required for transforming culture are brought to life, enabling a critical mass of people with transformational leadership skills to grow. Conclusions and implications for practice: The strength of this work is underpinned by the partner relationship, which drives the focus of innovative programmes of research, scholarship and continuing professional development so that the local university offers systematic support to the organisational strategic objectives of delivering person-centered, safe and effective evidence informed care. The support is designed to develop these skills, using learning and development strategies that draw on the power of the workplace for active learning, as well as focusing on the outcomes and impact important to service providers. Key messages include: Regardless of the size of any initiative, it is important to establish a shared purpose at the start Collaboration, inclusion and participation principles, and associated practice development methodology, enable a focus on achieving person-centred, safe and effective cultures at organisational and at micro-systems levels Once shared purpose is agreed, ways of working that reflect it also need to be agreed Systems for learning, development, research, innovation and evaluation need to be established that enable shared purposes and values to be embedded in everyday activity

Transforming end of life care using practice development: an arts-informed approach in residential aged care

Purpose: To demonstrate that practice development is an effective strategy to enable an aged care team to embed a palliative approach to care of dying people into practice culture. Method: Practice development methodology was integrated with an action research evaluation framework, as a systematic and reflexive process of inquiry aimed at achieving innovative and transformative end of life care. Drawing on multiple sources of observational, group and interview data, evidence-based guidelines and the use of arts-informed active learning methods, a multidisciplinary aged care team explored personal and professional values and beliefs about principles of care delivery. These were creatively translated into meaningful expressions of evidence-informed end of life care and embedded into daily clinical practice. Results: Reflexive analysis of multiple sources of data, alongside the use of evidence-based guidelines, supported the collaborative development of a ‘palliative care chest of drawers’ (PCCOD). As an artefact and one outcome of using practice development in the implementation of a palliative approach to care, the PCCOD brought visible, shared meanings and new ways of working to support care of people who are dying, their families, other facility residents and staff. The PCCOD enabled the aged care team to embed practice innovations into normative patterns of care. Conclusion: Practice development strategies are effective in enabling practitioner-led innovation in clinical practice through integrated inquiry and transformative processes. Implications for practice: The use of a practice development, arts-informed approach: Enables the creation of space for workbased learning and innovation, such as the development and use of the PCCOD to support the process of implementation of changes in practice Makes visible changes to practice, based on shared meanings of a palliative approach to end of life care that reflects the culture of the workplace Provides a creative strategic tool to engage others in the processes of transformation and collaboration, which takes initiatives from a small active learning group into the workplace Enables what was previously a ‘hidden’ part of care to be a distinctive care package that engages residents, families and all members of the aged care team

Enhancing transformational facilitation skills for nurses seeking to support practice innovation

Aims: To provide an overview of the development, implementation and process evaluation of a programme for nurses seeking to develop the knowledge and skills required to facilitate practice innovation. Method: The 12 month facilitation in clinical practice programme was underpinned by transformational practice development (tPD) methodology. The programme included a series of workshops, active learning groups and was supported by experienced facilitators, using a co-facilitation model. Evaluation occurred continuously throughout the programme. Results: Participants evaluated the programme positively and were able to apply their evolving knowledge and skills within their everyday practice. Their major areas of learning included active participation in their own learning, an increased valuing of diversity within the group and application of their learning in facilitation of practice development initiatives. The co-facilitation model was found to challenge and support ongoing development of the facilitators. Conclusions: Participation in the facilitation in clinical practice programme enhances nurses’ knowledge and skills for undertaking tPD.

Blending critical realist and emancipatory practice development methodologies: making critical realism work in nursing research

This paper examines the efficacy of facilitation as a practice development intervention in changing practice within an Older Person setting and in implementing evidence into practice. It outlines the influences exerted by the critical realist paradigm in guiding emancipatory practice development activities and, in particular, how the former may be employed within an emancipatory practice development study to elucidate and increase understanding pertinent to causation and outcomes. The methodology is based upon an emancipatory practice development approach set within a realistic evaluation framework. This allows for systematic analysis of the social and contextual elements that influence the explication of outcomes associated with facilitation. The study is concentrated upon five practice development cycles, within which a sequence of iterative processes is integrated. The authors assert that combining critical realist and emancipatory processes offers a robust and practical method for translating evidence and implementing changes in practice, as the former affirms or falsifies the influence that emancipatory processes exert on attaining culture shift, and enabling transformation towards effective clinical practice. A new framework for practice development is proposed that establishes methodological coherency between emancipatory practice development and realistic evaluation. This augments the existing theoretical bases for both these approaches by contributing new theoretical and methodological understandings of causation.

Starting a care improvement journey: focusing on the essentials of bedside nursing care in an Australian teaching hospital

To evaluate and improve patient assessment practices, care practices, recognition of patient deterioration and communication in the acute ward environment. A growing recognition of patient safety-related concerns in acute hospitals, a nursing shortage and a reduction in availability of skill and experience levels at the bedside led a group of clinicians to explore the issues that impacted on patient care at a ward level within their organisation. Multimethod practice development study. This paper reports phase one of concept development. A practice review was conducted using clinical audit processes that examined practice and documentation in relation to patient assessment parameters and care planning, specifically identifying whether changes in clinical parameters were identified and acted on. Results highlighted a clear discrepancy between the care that was identified on the nursing care plan and the care the patient was receiving. Actions as a result of the disappointing audit results included changes to education programmes, strategies to improve critical discussion regarding clinical practices and the development of assessable domains of nursing care that were relevant and realistic to ward-based nurses. The results enabled the identification of eight domains of care and associated care outcomes that target strategies for care improvement. Emancipatory practice development methodology will be used to further progress this work and ensure successful implementation into clinical units. This paper examines the critical discussions, audit processes and actions that took place, leading to the development of care outcomes for nurses.

Constructions of dignity: a pre‐requisite for flourishing in the workplace?

To explore the relationship between nurses' understanding of dignity and how it is enhanced and developed in their practice environment. Dignity is a ubiquitous concept in an era of healthcare reform yet is referred to almost exclusively in terms of the quality of care delivered to support the experience of the patient rather than the caregivers engaged in the relationships of care. This article focuses on dignity in the professional life of nurses in aged care. This is part of a doctoral study of the implementation of a palliative approach in residential aged care using emancipatory practice development methodology. Constructions of dignity were co-created with participants through creative reflective activities and subsequently analysed using reflexive methods and data from other sources within the study. Constructions of dignity and subsequent actions taken by nurses on their own behalf to articulate their experiences of transforming practice are interconnected with dignity enhancing relationships and emancipatory ways of working in practice development. Dignity enhancing ways of working in an active learning group and workplace have been interlinked with actions that promote person-centredness in developing a palliative approach to care.

Using practice development methodology to develop children’s centre teams: Ideas for the future

The Children's Centre Programme is a recent development in the UK and brings together multi-agency teams to work with disadvantaged families. Practice development methods enable teams to work together in new ways. Although the term practice development remains relatively poorly defined, its key properties suggest that it embraces engagement, empowerment, evaluation and evolution. This paper introduces the Children's Centre Programme and practice development methods and aims to discuss the relevance of using this method to develop teams in children's centres through considering the findings from an evaluation of a two-year project to develop inter-agency public health teams. The evaluation showed that practice development methods can enable successful team development and showed that through effective facilitation, teams can change their practice to focus on areas of local need. The team came up with their own process to develop a strategy for their locality.