Ideas for using a collaborative, inclusive and participatory approach

Jo Odell, FoNS Practice Development Facilitator

Recently I have noticed through my work that more and more healthcare organisations are investing heavily in quality improvement science and are running courses to help their staff develop their skills in this area. This in itself is very worthy, but I have been reflecting on the differences between a quality/service improvement approach and a practice development approach to changing practice. Laverty (2016) discusses this at length in his article and provides a case for some integration of the two approaches. However, in my experience there is one main difference, and that is the way that staff and patients are involved. In my experience quality improvement projects, are often led by an individual or a small team. The project team ‘introduce’ improved procedures/processes without much attention to the existing workplace culture and without involving the wider staff/stakeholder group. Which means that when the project team are not on duty, when project leaders move roles or the service becomes very busy, all the quality improvement work stops. Whereas when practice development principles (McCormack et al., 2013, p 5) are used to focus on and challenge the ‘ways we do things round here’, emphasis is given to everyone being involved using collaborative, inclusive and participatory approaches (Akhtar et al., 2016, p 6).

So now we find ourselves in the Christmas period and with ‘winter pressures’ showing themselves in very busy services, are you seeing that your quality improvement projects stalling? Our experience of working with a collaborative, inclusive and participatory approach with the Inspire Improvement fellows is that there are activities that you can incorporate into even the most stretched service to involve everyone. Indeed when the service is busy and staff are stretched, it’s even more important to engage in activities that include and value staff: small activities that show people they are listened to and that their opinion and voice is valued. Here are some examples of Christmas themed activities that the Inspire Improvement Fellows have been using:

*  An advent calendar with small thoughtful gifts for each member of staff
*  Using gift tags for individual staff members to record what is important to them and then using these to decorate a small tree
*  Staff and patients working together to create decorations and then decorating a Christmas tree display in a local church
*  Using an advent calendar to share with staff what patients feel is important about their care
*  Staff and patients in a mental health ward creating a Christmas tree together using plastic gloves (safety is a prime concern in this ward)

Perhaps you are already using activities in your own teams, so please share these with us. If not, can we challenge you to try and incorporate one at this busy time of year to enable everyone to feel part of the team and for your patients to feel involved too?


Akhtar, M., Casha, J.N., Ronder, J., Sakel, M., Wight, C.  and Manley, K. (2016) Leading the health service into the future: transforming the NHS through transforming ourselves. International Practice Development Journal. Vol.6. No. 2. Article. 5. Retrieved from: (Last accessed 4th April 2018)

Laverty, G. (2016) Quality improvement – rival or ally of practice development? International Practice Development Journal. Vol. 6. No. 1. Article 15. Retrieved from: (Last accessed 10th December 2018).

McCormack, B., Manley, K. and Titchen, A. (2013) Practice Development in Nursing and Healthcare. (Second Edition) Chichester: Wiley-Blackwell.

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