Practice Development Summer School. St Angela’s college. Sligo. 20th – 22nd July
Network of Hospice Friendly Hospitals
Office of Nursing & Midwifery of HSE
Mervyn Taylor. Programme Manager – Hospice Friendly Hospitals
In welcoming you here today, to this the first ever Summer School for Practice Development in End-of-Life Care ever held in Ireland, it would be remiss not to comment on the location near Lough Gill with its famous ‘Lake Isle of Inishfree’ and to remember the great words of our National Poet W.B. Yeats that “Education is not the filling of a pail but the lighting of a fire”.
What this Summer school is designed to do is to light the fires of creativity that will improve end-of-life care for those who die in our hospitals. And being concerned with lighting fires, rather than filling pails or buckets, we will be seeking to link passion with reason, creativity with care, challenge with support and imagination with implementation.
Summer Schools are very much an Irish solution to an Irish problem. That problem can be called anti-intellectualism but, put more simply, it is a problem of suspicion of ideas rather than outright opposition to them. The Summer School has developed as a forum for people to think out loud in public and engage in debate about important issues that for the remaining months of the year we have little time to think about and little patience for those who seem to be able to make the time.
Practice development is an interesting term. Garbett and McCormack (2002) have identified four key themes as being the purpose of practice development.
- A means of improving patient/service user care.
- Transforming the contexts and cultures in which nursing/healthcare takes place.
- Employing a systematic approach to effect changes in practice.
- Involving various types of facilitation for change to take place.
The words to note here are – Improving – Transforming – Systematic – Change. These words suggest others of which the two most important are innovation and creativity. Innovation and creativity, together with resilience, are now seen as central to the process of moving our country forward and out of the deep crisis in which it has been placed by fairytale finance and the temporary spell of affluenza. It is now commonplace for people to talk of the link between arts, culture, innovation and economic development. Despite all the HR rhetoric of the 1990s about ‘people being our most important resource’ what is not frequently talked about is the potential to develop ‘human capital’ (people) and innovation within our public services. All the attention has been on the Croke Park Agreement and on the need to cut staff numbers, costs and standardise the conditions across a myriad of organisations. These are necessary, if painful, tasks but when the dust settles will the public, for whom public services exist, not be getting more of the same – only less of it? Will ‘social partnership’ emerge again under a different name only to continue the practice of service providers talking to service managers to the exclusion of the provided for?
Peter Drucker, one of the great names of management theory stated that ‘The greatest danger in times of turbulence is not the turbulence; it is to act with yesterday’s logic’. We will be acting with yesterday’s logic if we do not debate and argue for more creativity and innovation within our public services, most especially our health services. Public service and innovation should not be contradictory terms. We have business entrepreneurs, we have increasing recognition of social entrepreneurs and we now need to focus on public service entrepreneurs; health service entrepreneurs* in particular.
What attitudes and approaches will help to promote innovation in our health services?
Firstly, a more critical approach to the term ‘best practice’. If, as some have pointed out, everyone were to implement best practice then there would be no best practice – simply uniformity. But this is to miss the point that in order to develop best practice we have to be creative and innovate.
Secondly, in order to innovate and move away from yesterday’s logic of specialisms operating in relative isolation, we need a more critical appreciation of patient or person-centredness. To focus on the individual service user in the abstract is to stay in the abstract and to avoid the hard work of actually studying the totality of the patient or service users experience of all the related services they encounter. There is no need to set aside the term ‘evidence based’ but there is an overwhelming need to understand and appreciate the term ‘experience based’ and there is a similar need to reassert our ‘values base’ which often determines the type of evidence we go looking for.
Thirdly, to improve the totality of the patient or service users experience we need to engage in pathfinding activities and projects that will help us establish what is going wrong and what is going right at the various stages of the patients journey. This is where the real challenge of public service reform lies; in getting the diversity of providers and players to engage in this process of pathfinding with a clear commitment to being creative and innovative in the redesign and provision of services that address the needs of the public and not just the concerns of the providers. This is the work that many idealistic people signed up to do in the public service but have so rarely found support for – they wanted to make a difference and were met with indifference.
Fourthly, there is a need to develop support and development networks and structures to promote creativity, innovation and change within our public services. If initiative is not to be squashed, and innovation stifled, then there will have to be something more substantial and sustainable than the Public Service Excellence Awards and theInstituteofPublic Administration.
It is in this space that there may be some hope of reviving the spirit, rather than the previous practice, of ‘social partnership’ – a space in which intellectual rigour, strong data, user experiences, provider perspectives and central coordination, rather than control, can foster a new approach. The importance of creative clusters is well understood in the information technology and creative media. We need to focus on helping pilot projects fly rather than offering them up as sacrifices to the great god of mediocrity. To do this we are going to have to get serious about bringing together like minds and related projects so that innovation is fostered rather than squandered.
We need to focus on ‘big picture’ issues such as the forms of care that are required for some highly dependent older people and see how a ‘life cycle’ approach can be developed right across the public services to meet their needs. Health, housing, income support, taxation, transport, and community support initiatives, and the interaction of one with the other, need to be examined. For this to happen in any effective way we need to stop talking ‘turf’ and ‘territory’ and start talking about ‘needs’ and ‘experiences’.
This then is ‘the big picture’. But what of ‘the small picture’? The work of practice development, taking in as it does the forward / backward paradox of reflective practice, is vital in developing the momentum for change and all engaged in it should rightly see themselves as ‘Champions for Change’. As has been pointed out, time and time again, organisations do not care for people; people care for people. Organisations can become institutionalised in their thinking. They need constant internal challenge to order to avoid the culture of ‘the way we always do it around here’. Developing the skills of effective and constructive challenge are central to this Summer School for Practice Development. This means that we first have to challenge ourselves, our perspectives, our language, our behaviour and our ideas of ourselves as ‘professionals’ before we earn the right to challenge the wider systems within which we work. To paraphrase an old saying,
‘As above so below. As within, so without’.
These links between personal attitudes, professional skills and behaviour, culture, organisational and systems change are not easily developed but they need to be appreciated for what they are; essential to wider processes of creativity and innovation without which our health and public services, our society, our economy and our country will not prosper. In this context it may be appropriate to ask if the skills and the senses that practice development seeks to grow should not be considered as part of the core skills essential for all servants of the public. What does it matter if some don’t want to call it practice development providing the objective remains the same.
I started by quoting Yeats so I may as well conclude by quoting him.
“The world is full of magic things, patiently waiting for our senses to grow sharper.”
These two days have been organised so that your senses can grow sharper.
Make the best of the two days ahead agus go n-éirí an t-ádh libh.