Presentation by Professor Ros Bryar, Professor Emeritus in Community and Primary Care Nursing, at the iHV Leadership conference on 7 December 2016. Creating a postive practice environment

1. Creating a Positive
Practice Environment
Ros Bryar, Trustee, iHV

2. Content
•Positive Practice Environment Campaign
•Elements of PPEs
•Benefits of PPEs
•Assessment of the practice environment
•PPEs in a different environment
•Levers for PPEs

3. Positive Practice Environments
Campaign
•‘PPEs are settings that support excellence
and decent work. In particular, they strive to
ensure the health, safety and personal
wellbeing of staff, support quality patient
care and improve motivation, productivity
and performance of individuals and
organisations.’ (ICN, 2008)
•The alternatives are environments that
constrain practice (Twigg and McCullough,
2014)

4. Positive Practice Environments
Campaign
•Launched in 2008
•Multidisciplinary focus
•Recognition of the international health
workforce crisis
•Aiming to improve practice environments to
enhance care and retention of health staff
•Initial focus on three countries: Morocco,
Uganda and Zambia
•Funding ceased in 2011 (Schmidt, 2012)
•PPE elements now incorporated into WHO
strategy: Workforce 2030

5. Some Elements of PPEs
•Occupational health and wellness policies
•Fair and manageable workloads
•Effective management, leadership, peer
support, staff participation in decision
making
•Professional identity, autonomy and control
over practice
•Support, supervision and mentorship
•Access to adequate equipment, supplies
and support staff (ICN, 2008)

6. Some Benefits of PPEs
•Higher quality care
•Staff satisfaction
•Enhanced teamworking
•Greater awareness of health and safety
•Greater participation in organisational
decision making
•Strong leaders promote shared values
•Staff retention

7. Assessment of the Practice
Environment
Lake’s (2002) assessment tool assesses:
•Nurse participation in hospital affairs
•Nursing foundations for quality care
•Nurse manager ability, leadership and
support of nurses
•Staffing and resource adequacy
•Collaborative nurse-physician relationships
Bryar, Kendall and Mogotlane (2012) PHC
Nursing Roadmap

8. Primary Health Care Nursing
Roadmap
Incentives
Education
Health and
safety
Leadership
and
managerial
support
Skill mix
Regulation
Competencies
Human
Resources for
Primary Care
Quality
Improvement
People
Centredness
Partnering and
inter-
professional
working
Information and
communication
technology
Public health
perspective

9. Work
Environment

10. Equipment

11. Work
Environment

12. External
environment

13. Making PPEs a Reality
Undertake an assessment of the current
environment
Apply learning from today’s conference on:
•Leadership
•Responding to and shaping change
•Collecting evidence
•Influencing
•Partnership working
•Incentives

14. Making PPEs a Reality
Make use of International Strategies:
•Sustainable Development Goals:
https://sustainabledevelopment.un.org/sd
gs
•WHO Workforce 2030
•APPG on Global Health: Triple Impact
Report: http://www.who.int/hrh/com-
heeg/triple-impact-appg/en/

15. SDGs: application to PPEs

16. WHO Workforce 2030
22. ‘Promote decent working conditions in all settings.
Ministries of health, civil service commissions and
employers should adopt gender-sensitive employment
conditions, remuneration and non-financial incentives.
They should cooperate to ensure occupational health
and safety, fair terms for health workers, merit-based
career development opportunities and a positive
practice environment to enable their effective
deployment, retention and adequate motivation to
deliver quality care and build a positive relationship
with patients.’ (WHO, 2016 p.17-8) (highlight added)

17. All-Party Parliamentary Group
on Global Health
Triple Impact of Nurses: Better health;
Greater gender equality; Stronger economies
•Recommendations include:
1. Raise the profile of nursing and make it
central to health policy
3. Develop nurse leaders and nurse leadership
4. Enable nurses to work to their full potential
5. Collect and disseminate evidence of the
impact of nurses on access, quality and costs

18. Creating a Positive Practice
Environment
•Assess the current environment for practice
•Identify areas for improvement
•Develop strategies to address issues making
use of international and national policies
•Implement and evaluate the impact of the
improvements on staff and on practice

19. PPEs: Realising the Value of
Nurses/HVs
‘We need to market nursing [health
visiting] as if it were a new drug or
treatment.
Heather Henry, UK nurse
entrepreneur’
(APPG, 2016 p.13)

20. References
• Bryar, R, Kendall S and Mogotlane S (2012) Reforming Primary Health Care: A Nursing Perspective
http://www.hrhresourcecenter.org/node/4090
• ICN (2008) positive practice environments for health care professionals. Fact Sheet. ICN, Geneva
• Lake ET (2002) Development of the practice environment scale of the Nursing Workforce index.
Research in Nursing & Health 25 (3) 176-88
• Schmidt, A (2012) Positive practice campaigns evaluation report. Global Health Workforce
Alliance, WHO, Geneva
http://www.who.int/workforcealliance/about/initiatives/PPEevaluation_2012.pdf
• Twigg D and McCullough K (2014) Nurse retention: a review of strategies to create and enhance
positive practice environments in clinical settings. International Journal of Nursing Studies 51 (1)
85-92
• WHO (2016) Global strategy on human resources for health: Workforce 2030. WHO, Geneva
http://apps.who.int/iris/bitstream/10665/250368/1/9789241511131-eng.pdf
Togo:
• Film ‘Exchange of Ideas’ from Togo visit on YouTube: https://www.youtube.com/watch?v=5D-
fNTP323M
• Blog on the City, University of London web site:
https://blogs.city.ac.uk/learningatcity/2016/05/18/nursing-and-midwifery-education-in-togo-
needs-assessment/#.V3QxM7grKhd