Unlocking the doors: introducing practice development to Canadian healthcare
Bibliographic record
Abstract
From my early days as a nursing assistant in complex continuing care, I recognised that all was not well in healthcare. I was particularly troubled with practices that I perceived to be antithetical to ‘caring’ and I struggled to facilitate change within my very limited circle of influence. I remember well the day I asked for the key to open the balcony doors on the unit so I could take patients out for a breath of fresh air. Being told by the registered nurse that ‘those doors haven’t been opened in 15 years and that isn’t going to change’, was what I now appreciate as the start of my practice development journey. Although I have had the privilege of observing and contributing to more quality healthcare practices in my subsequent roles as a registered nurse, advanced practice nurse and, most recently, Director of Interprofessional Practice, I am also keen to know how far we have yet to go in bringing that ‘fresh air’ I sought decades ago to our patients through more person centred means. I think our lack of progress can be attributed in part to evolving technologies in healthcare that pull our attention away from the human-to-human exchange that has the most impact on patients’ experience of care. Practice development holds the promise of keeping us focused on our caring practices, in balance with the seductive lure of high tech solutions, to address gaps in our quality care. Canada is not alone in its need of healthcare improvement; media and scholarly literature across the globe abound with examples of poor quality care and calls to action across healthcare sectors, settings and specialties. Canada is, however, distinct because of the absence of practice development as a systematically adopted methodology for meeting quality improvement priorities at provincial, national or even local levels. This is despite how embedded practice development has become at local and national levels in both practice and academic settings beyond North America, with examples including the Older Persons Services National Practice Development Programme in the Republic of Ireland, the New South Wales-based Essentials of Care programme in Australia and the England Centre for Practice Development hosted by Canterbury Christ Church University. These success stories, as well as the breadth of related theoretical and empirical literature that has evolved over the past 20 years, have not influenced Canadian healthcare practices much beyond the level of individual academics and practitioners – a relatively small group of converts.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.074 | 0.075 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.007 | 0.006 |
| Science and technology studies | 0.060 | 0.044 |
| Scholarly communication | 0.030 | 0.014 |
| Open science | 0.008 | 0.029 |
| Research integrity | 0.009 | 0.015 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".