This article describes how health service transformation can be aided by using ‘practice development’ as a vehicle for change at times of economic uncertainty. It explores the importance of understanding the needs of individuals in the workforce when engaging in a process of development and emphasises the importance of equipping leaders with the tools to understand individual practitioner's capacity to engage in a process of development. A review of existing measurement tools summarised within the paper indicates a paucity of valid and reliable instruments to support leaders to identify individual support needs at time of transformation and change. The article therefore recommends the development of further tools to support leaders to understand and respond to the individual needs within the workforce at times of development and change.

IntroductionA local health needs assessment indicated a need for end of life beds in a care setting for patients who did not want to, or could not, die at home or in hospital and did not have the level of need requiring a Hospice bed. Population predictions suggest this need will increase. A model of a Hospice commissioning and supporting beds in a nursing home was created and is currently being piloted.AimsThe overall aim was to develop a new model of end of life care in a care setting providing high quality care for patients and families.Project planThis included: developing eligibility criteria, a contract, operational policies, budget; undertaking publicity; preparing environment; planning evaluation; providing education.ResultsThe first 4 months indicateBenefits include:High quality of carePositive patient and carer satisfactionSaving of hospital bed days through admission avoidance and earlier discharge.Increased choiceRapid access to bedsReduced paperwork and administration time for professionalsIncreased psychological support for patients and familiesTraining and development of care home staffimproved care for all residentsImproved partnership working with acute trust, hospice and communityRapid access to medicines through Hospice nurses prescribingChanged perceptions of care homesCost effectiveChallenges includeIdentifying patients for referralEstablishing new referral pathwaysIssues around communicationLack of understanding by relatives of medical condition and prognosisTransfers felt rushed for some relativesConclusionsImplementing new models across hospitals and community takes time and presents challenges. However, early indications are that this model of high quality care is successful and has many benefits to patients, families and professionals. It could be replicated in other care homes.