While facilitating the first practice development school for our local healthcare authorities in Nova Scotia, Canada, recently, I was simultaneously preparing for my second hip replacement. Focusing workshop participants on the principles of practice development, collaboration, inclusion and participation, I wondered if, in my upcoming journey through the healthcare system, I would experience the processes and outcomes we were promoting in the school. I would like to share this commentary as a reflection of my practice development experience as a patient. Overall, I received care that was inclusive and collaborative – as well as care that was provider focused and system driven. It goes without saying that as a patient, I felt valued when I was included and felt part of the team when my wishes and expectations were taken into consideration. For me, inclusion in care correlates with valuing that patient as a participant in their care journey, as set out by practice development principle 6 (Manley, McCormack and Wilson, 2008) (Table 1).

My recent healthcare experience has led me to reflect further on the principles of practice development and its implications and challenges for local healthcare authorities. For example, my anaesthetist comes to mind as embodying practice development principles 2, 4, 6 and 8. The anaesthetist supported my wishes surrounding narcotics, and provided research- and practice-based evidence for each of his actions. Although the offering of additional narcotics is routine practice in hip surgery, I did not want this, so we discussed my expectations and developed a plan together that reflected my wishes. He actually chatted throughout the entire two-hour procedure. I was pleasantly surprised when he told me he provides care that focuses on the patient (practice development principle 1). Nevertheless, inconsistencies in the attention to person-centred practices across the microsystem reminded me that the system is not yet set up to enable a person-centred focus (practice development principle 2). Given that I had experienced hip surgery before, I had expectations for my care that aligned with my first experience. When I shared these expectations with care providers, the response I sometimes received was ‘I am not comfortable doing that’. In those moments, I felt the care was not about me, but rather about the comfort of the person providing the care. Care that meets the needs of the provider rather than those of the patient pre-empts opportunities for creativity and for flourishing moments (practice development principle 5). I experienced how a busy unit and the needs of the provider took priority over individual patient needs. At these moments I did not feel part of my care, nor did I feel that I mattered.

https://doi.org/10.19043/ipdj.61.013

This article by Erna Snelgrove Clarke is licensed under a Creative Commons Attribution Non-Commercial 3.0 License.