When thinking about the subject for this editorial, we found it hard to look beyond the current context of health and care and the continuous challenges faced by those striving to develop person-centred cultures, to enable the best outcomes and experiences for all. Through our work with clinically based practitioners, we have both noticed a concerning downward turn, with increasing reports of staff fatigue and ill health, workforce shortages and frequent changes in management, all at a time of growing levels of patient need. A perfect storm!

As I (Kate) prepared a presentation recently, I found myself thinking about the story of Hans, a small boy who found a leak in a dike and used his finger to plug the hole and save his town from a potential deluge of water. This reminded me of a recent supervision session, when I used the metaphor of a dam to help someone to explore the pressure they were experiencing. What was contributing to the force of water? What, if any, were the sources of water that were in their control to divert before they reached the dam? What was the nature of the bricks the dam was built from? How could the bricks be supported and strengthened? Where could more bricks be found?

But holding back the water is not in the gift of one individual. We need to share the load and work collaboratively to understand what is important and what matters to people (patients and staff), to prioritise where we put our efforts and energy. We also need to be innovative and creative, to explore what is possible, to enable people to be the best that they can be, and to offer hope and joy at a time when it is in short supply.

And so, what is encouraging, as we share this issue of the International Practice Development Journal with you, are the many ways in which the authors are doing just that.

This article by Kate Sanders and Caroline A.W. Dickson is licensed under a Creative Commons Attribution Non-Commercial 3.0 License.