A realist synthesis of effective continuing professional development (CPD): A case study of healthcare practitioners' CPD

Abstract

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.

The Venus model for integrating practitioner‐led workforce transformation and complex change across the health care system

“…Facilitators with the skills and qualities to use the workplace as the main resource for learning, development, and improvement is a feature identified in our research underpinning Venus . The facilitation focus has varied in purpose from growing the workforce within and across the system flexibly, through systems leadership, to helping the workforce through continuing professional development (CPD) achieve role clarity, career progression, and as high‐performing teams, adapt to the changing context to meet health needs, or, knowledge translation and culture change …”

“…Comprehensive and holistic facilitation skills and know‐how, therefore, support systems transformation through not just a focus on learning, but integrating all the key purposes required for transformation to enable a person‐centred, safe, and effective care to be provided. These skills are vital for systems leadership as a facilitator of learning, development, improvement, innovation, and inquiry focused on developing a workforce that can liberate its creativity and talent for creative solutions towards flexible solutions …”

The experience of hospital staff in applying the Gentle Persuasive Approaches to dementia care

“…Regular discussions in team huddles facilitated by the mental health nurse specialist generated opportunities to create a shared understanding of person‐centred care across disciplines. Teams with common understanding and shared values enable active generation of practical knowledge from practice (Manley, Martin, Jackson, & Wright, ). The joint process of sense‐making in team huddles helped the staff to identify practical ways to apply person‐centred care in GPA, anchoring theoretical knowledge in real‐world clinical practice.…”

“…This finding suggests a need to use a pragmatic approach to raise awareness and make person‐centred care more explicit and applicable in everyday practice (Van der Donk & Kuijer‐Siebelink, ). An effective facilitator helps to “enable others to use knowledge through active inquiry and evaluation of their own and collective learning” (Manley et al., , p. 138). Further research is needed to explore ways to enhance the clarity of person‐centred care theory in hospital practice (Dewing & Mccormack, ).…”

“…Involving leaders and nurse specialists in mental health to discuss ways of applying learning can create synergies in addressing challenges and building confidence in teamwork. The efforts of both the frontline staff and organization leaders can influence dementia care and play a key role in creating a supportive environment to facilitate change (Manley et al., ).…”