"I bet you wished you'd picked a different group": an ethnographical study of practice development unit accreditation.

Abstract

Research Aims Practice development accreditation is growing rapidly as it is praised for transforming cultures of health care, inciting empowerment, instigating multidisciplinary teamwork and creating more effective services. However, literature is vague on what occurs during accreditation, the role of culture within this process and the experiences of different professional groups in practice development. This research therefore sought to address the following research aims: To investigate practice development accreditation by studying a unit undertaking this process To examine the culture of a unit during accreditation To portray a multidisciplinary account of practice development Method These aims were investigated by conducting a twelve month observational study of a group undertaking the accreditation process. Despite the accreditation attempt being unsuccessful, important concepts around leadership and culture emerged. Findings This study found that the core group of practitioners instigating practice development lacked shared beliefs, aims or commitment which caused disputes (particularly over the distribution of work) and that a lack of management support dampened morale and made progression difficult. The core group's leadership style also hindered the accreditation attempt as they both restricted and forced involvement from the staff, leaving them feeling unempowered and reluctant to participate. Finally, the participants were unable to overcome divides based on hierarchical and professional identity to work as part of a multidisciplinary team in order to implement practice development. Recommendations Four recommendations for the instigators of any empowering change initiative emerged. These are: i) to create a 'vision' in order to ensure the entire organisation understands the purpose and goal of implementing changes; ii) to erode divides between employees that are based on professional and hierarchical identities; iii) to create succession plans in order to maintain effective leadership; iv) those initiating change should understand the notion of functional conflict. Further Research This study suggests further research is needed into the roles of excluded professionals in practice development, to explore the relationship between accredited and non-accredited units within organisations, to assessthe impact of gender within practice development units, to discover how units successfully achieve accreditation and the strategies utilised by ethnographers to disengage from the field.