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Keywords:

  • change theory;
  • health care education;
  • individuals;
  • practice development;
  • realistic evaluation;
  • resource efficiency

Abstract

Background  Research indicates that multifaceted practice development (PD) interventions are more effective than single strategies. However, models of education in health care need to consider cost-effectiveness.

Objectives  This paper presents a research-based, PD theory called the Individual Practice Development Theory. It argues that programmes that use the Individual Practice Development Theory to tailor PD support to the learning needs of practitioners will result in more engagement in PD and will target PD resources efficiently.

Methods  The in-depth qualitative, multi-method realistic evaluation was of a multifaceted, organization-wide PD programme in one National Health Service Mental Health and Learning Disabilities Trust. Semi-structured interviews, practice observation and documentation audit were used to gather data from occupational therapists.

Findings  Results indicated that environmental contexts, particularly the support of the immediate team, and the participant's personal circumstances affected PD behaviour change. Six mechanisms acted as catalysts. These were: Building Confidence, Finding Flow, Accumulating Reward, Conferring with Others, Constructing Knowledge Know-how and Channelling Time. Four stages of PD characterized as: ‘In the Hangar’, ‘On the Runway’, ‘Take-off’ and ‘In the Air’ were identified. The research also illustrated the interconnectivity between outcome levels, contextual circumstances and activating mechanisms.

Discussion  The findings suggested that PD interventions need to be more individually tailored to achieve optimum learning outcomes. The identification of four discernable stages permits rapid understanding of PD support needs in order to focus PD support.

Conclusion  With a systematic and individualized approach to PD in health care, more target PD supports can be put in place.