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PubMed2000

Organisational development in general practice: lessons from practice and professional development plans (PPDPs).

BACKGROUND: Improving the quality and effectiveness of clinical practice is becoming a key task within all health services. Primary medical care, as organised in the UK is composed of clinicians who work in independent partnerships (general practices) that collaborate with other health care professionals. Although many practices have successfully introduced innovations, there are no organisational development structures in place that support the evolution of primary medical care towards integrated care processes. Providing incentives for attendance at passive educational events and promoting 'teamwork' without first identifying organisational priorities are interventions that have proved to be ineffective at changing clinical processes. A practice and professional development plan feasibility study was evaluated in Wales and provided the experiential basis for a summary of the lessons learnt on how best to guide organisational development systems for primary medical care. RESULTS: Practice and professional development plans are hybrids produced by the combination of ideas from management (the applied behavioural science of organisational development) and education (self-directed adult learning theories) and, in conceptual terms, address the lack of effectiveness of passive educational strategies by making interventions relevant to identified system wide needs. In the intervention, each practice participated in a series of multidisciplinary workshops (minimum 4) where the process outcome was the production of a practice development plan and a set of personal portfolios, and the final outcome was a realised organisational change. It was apparent during the project that organisational admission to a process of developmental planning needed to be a stepwise process, where initial interest can lead to a fuller understanding, which subsequently develops into motivation and ownership, sufficient to complete the exercise. The advantages of introducing expert external facilitation were clear: evaluations of internal group processes were possible, strategic issues could be raised and explored and financial probity ensured. These areas are much more difficult to examine when only internal stakeholders are engaged in a planning process. CONCLUSIONS: It is not possible to introduce practice and professional development plans (organisational development and organisational learning projects) in a publicly funded health care system without first addressing existing educational and management structures. Existing systems are based on educational credits for attendance and emerging accountability frameworks (criteria checklists) for clinical governance. Moving to systems that are less summative and more formative, and based on the philosophies of continual quality improvement, require changes to be made in the relevant support systems in order achieve policy proposals.

Evidence-Based Medicine↗
PubMed1988

First Five-Year National Development Plan, 1986-1990.

Provisions of this Zimbabwe Development Plan relating to population and family planning are as follows: "Government will continue to extend family planning services to all parts of the country in order to further reduce population growth to levels consistent with economic growth and the objective of raising the living standards of society."

Africa↗
PubMed2002

Learning to plan? A critical fiction about the facilitation of professional and practice development plans in primary care.

A shift from continuing medical education towards professional and organisational development policies, coupled with the introduction of accountability frameworks (clinical governance), has generated interest in professional and practice development plans (PPDPs) in general practice. The problems of implementing this change in an independent contractor-based service remain unexplored and the aims of this study were to focus on the facilitator's experience of the issues that hampered or fostered development in general practice. Facilitators of PPDPs were asked to document their experience of supporting 12 practices in an all Wales feasibility study. In order to maintain organisational anonymity while reporting accurate accounts of the obstacles encountered, a method known as critical fiction was employed. This method allowed the authors to write detailed reflective accounts that were then fictionalised. The culture of general practice reflects the development of an independent contractor service that has developed into partnerships that employ some professionals (practice nurses, managers and administrative staff) and collaborate with others in variable arrangements (community nurses, health visitors, midwives and others). Developing organisation-wide systems in so-called 'primary health care teams' is a difficult exercise, given the ethos of autonomous decision-making processes and the lack of experience of 'whole systems' approaches in primary care. The potential for multiprofessional synergy and the evidence that systematic changes lead to sustained health care improvements are well established. But the implementation issues of these concepts have not been addressed. Existing educational policies are based in uniprofessional paradigms and the protected time requirements and funding streams required for PPDPs have not been clarified.

Attitude of Health Personnel↗
PubMed1992

Beam's eye view volumetrics: an aid in rapid treatment plan development and evaluation.

A well-designed treatment plan fully irradiates the target to the prescribed dose while minimizing radiation to adjacent critical structures. Beam's eye view is an important component of treatment planning systems because it provides the operator with tools needed to achieve this goal. Through interactive manipulation of displays, the planner uses beam's eye view to adequately cover the target volume while geometrically avoiding certain critical, normal structures. A factor not considered in current beam's eye view programs is the fractional volume of each structure irradiated given a specified beam direction. We have incorporated a rapid volume calculation capability in our beam's eye view program, and have applied it to provide a quantitative aid to treatment planning development and evaluation. Treatment planning of lung tumors has been studied using this tool. Volumes of lung and spinal cord treated as a function of portal angle may be calculated much more rapidly than dose volume histograms and yet provide quantitative indices which follow the trends of dose volume histograms as a function of field angle. Plots of normal tissue volume irradiated as a function of field angle identify the optimal angle to minimize irradiated volume of a structure at a glance. For multiple field plans, a bitmap approach identifies areas treated by various combinations of beams. Volumetrics combined with beam's eye view are useful in treatment planning because they (a) provide quantitative information needed in choosing and optimizing portal entry angle (b) provide an interactive approach to understanding the relative merits of different multiple field plans and (c) complement the information provided by the more time consuming generation of dose volume histograms. The clinical application of this tool in treatment planning is presented.

Computer Graphics↗
PubMed1975

Nutrition and national development planning.

We have argued that development strategies aimed at the reduction of all forms of deprivation, according to an explict statement of values and priorities, are necessary for the integration of nutrition planning into overall national development planning. We do not regard this as likely to lead to the neglect of the key issues of investment and production. Instead, we argue that consideration of investment and production strategies should be explicitly directed to their purpose, the reduction of deprivation, rather than, as in the past, treated as the necessary means to that purpose. Thus investment and production strategies would be aimed directly at relieving deprivation including, especially, nutritional deprivation, and their impact in this respect will need to be explicitly predicted and evaluated. We have argued that problems and potentials differ greatly at the area level and that planning must be an iterative process in which national and area-level strategies and programmes are brought to consistency through successive cycles of adjustment and reappraisal. A major role in planning, especially in detailed design and implementation, is assigned to area level. Planning must proceed from an identification of the deprivations under attack to the identification of intervention measures. Elsewhere we have argued the case for the 'functional classification" of malnutrition and the use of "typical profiles" in the understanding of "the ecology and etiology of malnutition". Where planning accepts the need for an integrated approach to the attack on all forms of deprivation, these analyses of nutritional deprivation would from part of a more comprehensive analysis of general deprivation. The existence of "functional classification" and "typical profiles" analysis with respect to malnutrition would provide an excellent base from which a more comprehensive view might be developed. The factors affecting the evolution of nutritional - and other - deprivation problems need to be understood in order that we can identify points in the system where intervention may control theri emergence. In any situation there will be alternative intervention points bearing either directly on the alleviation of symptoms (malnutrition) or, more or less indirectly, on the control of its causes. In general, mixed strategies will be called for. At this stage in our understanding no generalizations are possible about the nature of strategy choices. Our choice of intervention measures must be based upon an understanding of the overall system as it generates malnutrition, and of which forces exert the most powerful effects. One important element of this analysis will be an understanding of the behaviour of the malnourished. However, conventional planning approaches, in which ministries and departments concern themselves only with problems and measures which conform to the definition of their own spheres of responsibility, have failed to define these choices effectively...

Child↗
PubMed2002

One Dorset practice's experience of using a quality improvement approach to practice professional development planning.

There has been considerable discussion on and recommendation of the idea that Practice Professional Development Plans (PPDPs) should develop the whole practice as a healthcare resource, integrating and improving the educational process. In this study the PPDP concept was launched in a practice in Dorset, following the Bournemouth PPDP framework. The practice linked the educational activities of individuals, small working groups and the whole team to meeting the needs of the patients using a continuous quality improvement approach. The learning needs of the practice team were identified and learning actions were planned leading to a better response to patients' needs.

Education, Medical, Continuing↗
PubMed2000

GP selection of postgraduate education courses has implications for colleagues: messages for course providers and for those writing practice professional development plans.

BACKGROUND: The Department of Health's review of continuing professional development in general practice advocates setting team and individual goals. AIM: To explore how general practitioners (GPs) share learning experiences with colleagues, focusing on how GPs choose courses as one factor influencing sharing. METHOD: Interviews were conducted with 21 GPs using grounded theory methodology. The responses were coded by six researchers from psychology, education, and general practice. RESULTS: Much sharing with colleagues took place, though not always immediately following a course. GP explanations revealed four reasons for course selection that influenced the degree of sharing: 1. Attendance to meet group needs encouraged rapid sharing and could involve course attendance with colleagues. 2. Attendance to enhance 'special interests' could either encourage or inhibit sharing. 3. Attendance in pursuit of 'personal interests' peripheral to general practice did not result in sharing within the primary care team. 4. Attendance to meet personal learning needs did not involve sharing when needs were not currently shared with colleagues. CONCLUSION: Course selection and subsequent sharing have implications for course providers and those writing personal and practice professional development plans.

Curriculum↗
PubMed1990

Population redistribution policies and development planning in the Pacific Basin: rationale and objectives.

"In this article, the general arguments about population redistribution are discussed within the context of [Pacific island nations]....A review of circular and permanent population movements in the Pacific Basin reveals the complexity of the networks of relations of multilocal people....A range of possible population policies to accomodate and correct migration problems is discussed. An analysis of the national development plans of Fiji, Kiribati, and the Solomon Islands illustrates the need for sustainable development and population redistribution policies which explicitly address: (a) nation-building with regional equity; (b) population growth control and native supremacy; and (c) population redistribution with ecological sustainability." Comments are included by A. Crosbie Walsh (pp. 102-6) and Antony J. Dolman (pp. 107-11).

Demography↗
PubMedDate not supplied

Dynamics of a medical staff development plan.

All hospitals must work at retaining a strong, stable, and highly qualified medical staff. To successfully do this requires a formal medical staff development plan. Institutions without such plans could be operating at a loss down the road.

Medical Staff, Hospital↗
PubMed1982

International migration in the Dominican Republic: implications for development planning.

"The Dominican Republic represents a microcosm of all the major migration patterns: substantial emigration and immigration, sizeable return migration, and persistent internal rural-urban migration. The impacts of these various types of migration are related and have a significant influence on the development process. This study analyzes the causes of these migrations as well as the costs and benefits in terms of the individual migrants and the country as a whole. Finally, it investigates the implications of migration for development planning in the Dominican Republic." The authors conclude "that the migration issue is not an area distinct from the various development focuses, but rather cuts across and is related to many of the program areas in which the government is involved."

Americas↗
PubMed2001

The development of practice professional development plans from the postgraduate education allowance: a discussion of the causes and implications.

Practice professional development plans (PPDPs) began to replace the Postgraduate Education Allowance (PGEA) for general practitioners in England and Wales from April 2000. The origin of this change lies with those with educational expertise who have been concerned that the PGEA fails to encourage GPs to define their own learning needs, fails to encourage practice-based learning and fails to influence their working behaviour. The policy has been influenced however, by wider political developments which view PPDPs as a means to ensure national standards are met, to reassure the public, provide uniformity and deal with underperforming doctors. This mixture of influences has resulted in conflicting areas within PPDPs. There are different emphases on whether learning needs should be defined from the perspective of the individual or from the perspective of wider needs within the NHS. There are conflicting views about the desirability of multi- or uniprofessional learning and conflicting views about whether PPDPs are appropriate for dealing with failing doctors. PPDPs are based on a particular theory of adult learning - andragogy - which arguably fails to account for wider, richer and more significant forms of learning.

Education, Medical, Continuing↗