Puzzling practice: a strategy for working with clinical practice issues.

Area of Science:

• Healthcare Practice Development
• Clinical Problem-Solving
• Action Theory

Background:

• Clinical practice presents complex issues that require innovative exploration methods.
• Existing approaches may not adequately address the nuanced challenges faced by clinicians.
• Practice development is crucial for enhancing healthcare quality and effectiveness.

Purpose of the Study:

• To present the evolution and application of "puzzling practice" as a method for exploring and reframing clinical issues.
• To delineate the elements and techniques of puzzling practice developed over two years.
• To illustrate a specific framework of puzzling practice useful for clinicians and teams.

Main Methods:

• Action theory-based processes were employed over a two-year period by four authors.
• Development and application of several frameworks for "puzzling practice" in practice development and research.
• Utilizing a semi-fictitious example to illustrate the seven elements of a particular puzzling practice approach.

Main Results:

• The paper details seven elements of a specific "puzzling practice" framework: naming the issue, puzzling the issue, testing the puzzle, exploring the heart of practice, formulating the puzzle question, visualizing the future, and generating new strategies.
• Each element is explored through a narrative example and its underlying theoretical foundations.

Conclusions:

• "Puzzling practice" offers a structured yet flexible method for clinicians and teams to engage with and resolve complex practice issues.
• The seven-element framework provides a practical tool for enhancing problem-solving and strategy development in healthcare settings.
• This approach supports continuous practice improvement and innovation within everyday clinical work.