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BackgroundContinuing professional development (CPD) in healthcare is fundamental for making sure frontline staff practice safely and effectively. This requires practitioners to update knowledge and skills regularly to match the changing complexity of healthcare needs. The drive towards using limited resources effectively for service improvements and the need for a flexible workforce necessitate a review of ad hoc approaches to CPD.ObjectiveTo develop strategies for achieving effective CPD in healthcare.DesignA case study design drawing on principles of realist synthesis was used during two phases of the study to identify and test what works and in what circumstances.SettingOne National Health Service Trust in South East England.ParticipantsCPD stakeholders including professional regulatory bodies (n = 8), commissioners of healthcare (n = 15), facilitators of clinical skills development (n = 34), NHS staff in clinical leadership positions (n = 38), NHS staff undertaking skills development post graduate programs (n = 31), service user advocates (n = 8) and an international expert reference group (ERG) (n = 10).MethodsData sources included a review of scholarly and grey literature, an online survey and a consensus workshop. Thematic and content analyses were used during data processing.ResultsThe findings present four interdependent transformation theories comprising transforming individual practice, skills for the changing healthcare contexts, knowledge translation and workplace cultures to optimize learning, development and healthcare performance.ConclusionsThe transformation theories contextualize CPD drivers and identify conditions conducive for effective CPD. Practitioner driven CPD in healthcare is effective within supportive organizations, facilitated workplace learning and effective workplace cultures. Organizations and teams with shared values and purpose enable active generation of knowledge from practice and the use of different types of knowledge for service improvements.

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BackgroundOvercrowding in emergency departments is a global issue, which places pressure on the shrinking workforce and threatens the future of high quality, safe and effective care. Healthcare reforms aimed at tackling this crisis have focused primarily on structural changes, which alone do not deliver anticipated improvements in quality and performance. The purpose of this study was to identify workforce enablers for achieving whole systems urgent and emergency care delivery.MethodsA multiple case study design framed around systems thinking was conducted in South East England across one Trust consisting of five hospitals, one community healthcare trust and one ambulance trust. Data sources included 14 clinical settings where upstream or downstream pinch points are likely to occur including discharge planning and rapid response teams; ten regional stakeholder events (n = 102); a qualitative survey (n = 48); and a review of literature and analysis of policy documents including care pathways and protocols.ResultsThe key workforce enablers for whole systems urgent and emergency care delivery identified were: clinical systems leadership, a single integrated career and competence framework and skilled facilitation of work based learning.ConclusionsIn this study, participants agreed that whole systems urgent and emergency care allows for the design and implementation of care delivery models that meet complexity of population healthcare needs, reduce duplication and waste and improve healthcare outcomes and patients’ experiences. For this to be achieved emphasis needs to be placed on holistic changes in structures, processes and patterns of the urgent and emergency care system. Often overlooked, patterns that drive the thinking and behavior in the workplace directly impact on staff recruitment and retention and the overall effectiveness of the organization. These also need to be attended to for transformational change to be achieved and sustained. Research to refine and validate a single integrated career and competence framework and to develop standards for an integrated approach to workplace facilitation to grow the capacity of facilitators that can use the workplace as a resource for learning is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1616-y) contains supplementary material, which is available to authorized users.

Background: In order to provide improved care provision, integrated care services are being developed. However, little is known about how people living with dementia, their families and healthcare professionals experience integrated care. Therefore, the purpose of this review of the qualitative literature was to examine the experiences and perceptions of integrated dementia care. Methods: This qualitative review synthesised findings from included studies identified from a comprehensive literature search. Searches included: five electronic databases, journal handsearching, and reference list searching of relevant literature reviews and the final included studies. Findings: Three overarching themes were identified: 1) Ways of working which facilitate the delivery of integrated dementia care; 2) Informal carers as equal partners in care provision and decision making; and 3) Challenges leading to fragmented and disjointed integrated dementia care. For integrated care to be successful, communication and collaboration between healthcare professionals, and the involvement of informal carers is needed. Multidisciplinary teams and employing case managers to coordinate care provision can improve communication and collaboration. However, distrust between healthcare professionals and a lack of a central database to access and share information often hinders the development of integrated dementia care service provision. Conclusion:Integrated dementia care can be successful and well received by people living with dementia and their families when certain conditions are met. However, given the negative consequences fragmented and disjointed care can have on people living with dementia and their families, action is needed to further support the development of integrated dementia care services.