enhance: spotlight on transformative reflection

Transformative reflection is a type of reflective practice that can transform our sense of work-based identity, our sense of purpose, and how we work – ultimately influencing our collective wellbeing" (enhance Transformative Reflection guide 2023)

As healthcare professionals, we are learning and developing our attitudes and skills throughout our entire careers. We learn from the good days and the challenging days; we learn from our patients and our colleagues – all with the shared goal of providing the best possible patient care. But it can be so easy – and understandable – to keep our focus on the next pressing task at hand and choose not to make time to pause and reflect. Some of us may see reflection as a competency-based tick box exercise, or an unwelcome invitation to dwell on negative events. We may not have the knowledge or skills to reflect well, and it can feel overwhelming knowing where to start in a climate where workloads are high and teams across the NHS are stretched. Precisely because of this, it has never been a more important time to make reflective practice a priority.  

At Health Education England, we believe reflection is an essential skill for clinicians, which is why we have developed new resources to support people through this process. Transformative reflection is the second of four cross-cutting themes of the Enhancing Generalist Skills programme (enhance), which aims to equip a new generation of healthcare professionals with generalist skills. This is being trailblazed across England and is a hugely important step towards embedding generalist skills in healthcare education and the wider health and care system. Within enhance, learners are encouraged to take a more holistic view of their role within healthcare – a shift in practice which requires a significant reframe of existing professional beliefs.

The concept of transformative reflection is a powerful tool that can support this paradigm shift and lends itself well to learning from experiences in a clinical environment. Based on transformative learning theory, it proposes that peoples’ perspectives on the world around them change when they reflect on new experiences that challenge their world view. Educational research demonstrates that transformative reflection has positive impacts on individuals, teams and ultimately, patient care. For example, undertaking reflection with a focus on positive events can have a beneficial impact on staff wellbeing, and sharing reflections in group settings, such as a team debrief, can also foster a sense of community and peer support. Research also highlights that critical reflection used effectively is associated with deeper learning, understanding, and empathy, which ultimately drives the cycle of improving patient care and outcomes.  

To support our enhance learners’ reflective practice, a transformative reflection guide has been created in collaboration with a working group of subject matter experts. The guide recommends a selection of practical options for facilitating reflective practice in a way that best suits individual learning styles, such as creative writing, audio journals or attending Balint groups. The guide also champions the importance of providing appropriate support for learners and faculty to encourage a psychologically safe environment.   

It is a hugely challenging time for the NHS and healthcare professionals are under increasing pressure in a variety of ways. But it is so important that we prioritise and protect some space for reflective practice – as the benefits are clear for both patients and staff. It can help us deliver the best person-centred care, be excellent colleagues and safeguard the wellbeing of our workforce. By making purposeful sense of our experiences, we can develop our abilities to re-imagine how care is designed and delivered, for the good of both individuals and the collective.  

Download our enhance transformative reflection guide