Healthcare Quality Improvement and 'work engagement'; concluding results from a national, longitudinal, cross-sectional study of the 'Productive Ward-Releasing Time to Care' Programme (original) (raw)
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International Journal of Nursing Studies
Background Quality improvement (QI) Programmes, like the Productive Ward: Releasing-time-to-care initiative, aim to ‘engage’ and ‘empower’ ward teams to actively participate, innovate and lead quality improvement at the front line. However, little is known about the relationship and impact that QI work has on the ‘engagement’ of the clinical teams who participate and vice-versa. Objective This paper explores and examines the impact of a large-scale QI programme, the Productive Ward, on the ‘work engagement’ of the nurses and ward teams involved. Design/Methods Using the Utrecht Work Engagement Scale (UWES), we surveyed, measured and analysed work engagement in a representative test group of hospital-based ward teams who had recently commenced the latest phase of the national ‘Productive Ward’ initiative in Ireland and compared them to a control group of similar size and matched (as far as is possible) on variables such as ward size, employment grade and clinical specialty area. Results 338 individual datasets were recorded, n = 180 (53.6%) from the Productive Ward group, and n = 158 (46.4%) from the control group; the overall response rate was 67%, and did not differ significantly between the Productive Ward and control groups. The work engagement mean score (± standard deviation) in the Productive group was 4.33(± 0.88), and 4.07(± 1.06) in the control group, representing a modest but statistically significant between-group difference (p = 0.013, independent samples t-test). Similarly modest differences were observed in all three dimensions of the work engagement construct. Employment grade and the clinical specialty area were also significantly related to the work engagement score (p < 0.001, general linear model) and (for the most part), to its components, with both clerical and nurse manager grades, and the elderly specialist areas, exhibiting substantially higher scores. Conclusions The findings demonstrate how QI activities, like those integral to the Productive Ward programme, appear to positively impact on the work engagement (the vigour, absorption and dedication) of ward-based teams. The use and suitability of the UWES as an appropriate measure of ‘engagement’ in QI interventions was confirmed. The engagement of nurses and front-line clinical teams is a major component of creating, developing and sustaining a culture of improvement. Keywords Employee EngagementHealth service researchHospital unitsLean HealthcareMultidisciplinary Care TeamNurse AttitudesProductive WardProgram ImplementationQuality improvement
International journal of health care quality assurance, 2012
Key words: Lean Thinking, productive ward, efficiency, quality improvement, diffusion of innovation ABSTRACT Purpose: This paper is concerned with facilitating large-scale quality improvement in health care, and specifically understanding more about the known challenges associated with implementation of Lean innovations: receptivity, the complexity of adoption processes, evidence of the innovation, and embedding change. Lessons are drawn from the implementation of The Productive Ward: Releasing Time to Care TM programme in English hospitals.
Journal of Advanced Nursing, 2012
Aims. To test a model that suggests the ward's climate of service facilitates nurses' patient-centred care behaviours through its effect on nurses' work engagement. Background. Organizational efforts to promote patient-centred care focused on interventions aimed to improve nurses' communication skills, or to improve patient's participation in the decision-making process. These interventions have been only partially successful, as they do not take the ward context into account; so caring professionals who attend workshops can rarely apply their newly acquired skills due to the daily pressures of the ward. Method. A nested cross-sectional research design (nursing staff within wards) was adopted, with three measures of the care behaviour of nurses. Data were collected in 2009, from 158 nurses working in 40 wards of retirement homes in northern Israel. Nurses' work engagement, ward's climate for service and control variables were measured via validated questionnaires. Patient-centred care behaviours were assessed by structured observations. Results. The findings supported our model: service climate proved a link to nurses' work engagement and patient-centred care behaviours. Nurses' work engagement mediated the service-climate patient-centred care behaviours. Conclusion. The research is pioneering in demonstrating a close relation between ward service climate and patient-centred care. In practice, to improve patient-centred care managers should invest in facilitating ward service climate, highlighting the importance of service to the organization through appropriate rewards, guidance and administrative practices.
Quality & Safety in Health Care, 2010
Objectives To identify factors affecting doctors' engagement with the Safer Patients Initiative (SPI). Design Qualitative interview study. Setting Four organisations participating in phase 1 of the SPI programme, from four different geographical locations in the UK. Participants 34 staff members, comprising senior executive/management leads involved in the SPI programme, the principal SPI programme coordinator and the operational leads in each of the SPI clinical work areas. Main outcome measures Staff perceptions of issues affecting medical engagement with SPI, identified in the interviews.
Journal of Nursing Management, 2013
The Productive Ward: Releasing Time to Care ™-What we can learn from the literature for implementation Aim This paper reviews the Productive Ward: Releasing Time to Care™ literature, identifying and discussing the key characteristics that may contribute to successful implementation. Background It is 5 years since the official UK launch of the Productive Ward, and the Republic of Ireland commenced a phased, national implementation programme in 2011. Thus it is timely to reflect on the implementation lessons learned to date and described in the literature. Evaluation Using taxonomic mapping, this paper evaluates the current state of the literature that pertains to Productive Ward implementation experience; success factors; reports, and assessments. Key issues Seven common contextual characteristics were identified: robust and engaging communication; enabling and empowering roles; appropriate training; project planning and management; leadership; corporate/management engagement and support; and financial and human resource commitment. Conclusion The key characteristics identified have a direct impact on the implementation of the Productive Ward. The interplay between these key characteristics and how this interplay influences successful implementation of the Productive Ward warrants further research. Implications for nursing management Acknowledging and embracing the seven characteristics during implementation will positively improve the progress and success of the initiatives implementation.
Journal of clinical nursing, 2011
Abstract Purpose – This paper aims to focus on facilitating large-scale quality improvement in health care, and specifically understanding more about the known challenges associated with implementation of lean innovations: receptivity, the complexity of adoption processes, evidence of the innovation, and embedding change. Lessons are drawn from the implementation of The Productive Ward: Releasing Time to Care™ programme in English hospitals. Design/methodology/approach – The study upon which the paper draws was a mixed-method evaluation that aimed to capture the perceptions of three main stakeholder groups: national-level policymakers (15 semi-structured interviews); senior hospital managers (a national web-based survey of 150 staff); and healthcare practitioners (case studies within five hospitals involving 58 members of staff). The views of these stakeholder groups were analysed using a diffusion of innovations theoretical framework to examine aspects of the innovation, the organisation, the wider context and linkages. Findings – Although The Productive Ward was widely supported, stakeholders at different levels identified varying facilitators and challenges to implementation. Key issues for all stakeholders were staff time to work on the programme and showing evidence of the impact on staff, patients and ward environments. Research limitations/implications – To support implementation, policymakers should focus on expressing what can be gained locally using success stories and guidance from “early adopters”. Service managers, clinical educators and professional bodies can help to spread good practice and encourage professional leadership and support. Further research could help to secure support for the programme by generating evidence about the innovation, and specifically its clinical effectiveness and broader links to public expectations and experiences of healthcare. Originality/value – This paper draws lessons from the implementation of The Productive Ward programme in England, which can inform the implementation of other large-scale programmes of quality improvement in health care.
Journal of General Internal Medicine, 2020
BACKGROUND: Healthcare workforce engagement may represent a proactive approach against provider burnout, a widely prevalent condition that is associated with poor patient outcomes. OBJECTIVE: We examine whether workforce engagement is associated with better hospital performance, measured as lower inpatient mortality, in English National Health Services (NHS) acute Trusts. DESIGN: Panel study using cross-lagged regression, applying an optimally time-lagged value of the dependent variable as covariate to account for unmeasured Trust characteristics. PARTICIPANTS: NHS acute Trusts and respondents to the NHS Staff Surveys, 2012-2018. MAIN MEASURES: We measured engagement using three survey questions corresponding to validated engagement factors, and hospital performance using the Summary Hospital-level Mortality Indicator (SHMI). In the first analyses, associations of SHMI (dependent variable) with workforce engagement in the current, prior, and subsequent years were studied to find the optimum lag period for lagged regression analysis. In the subsequent cross-lagged regression analysis, bi-directional associations between SHMI and engagement were studied. Heterogeneity in engagement components across Trusts was studied in detail for the year 2017. KEY RESULTS: In the first analyses, current SHMI was negatively associated with engagement in the current year (ß = − 0.044; p = 0.035) more than with the prior year (ß = − 0.037; p = 0.049). In the second analysis, (a) engagement predicted same-year SHMI after controlling for prior-year SHMI (ß = − 0.044; p = 0.035). A 1-unit higher engagement score was associated with 4.4% lower SHMI. (b) SHMI predicted engagement in the same year (ß = − 0.066; p = 0.001) after controlling for prior-year engagement. More in-depth analysis showed high inter-trust heterogeneity on all three engagement factors (I 2 > 85%). CONCLUSION: Higher workforce engagement predicts lower mortality which in turn predicts engagement. Heterogeneity in workforce well-being suggests an opportunity to foster mutual learning across Trusts.
Journal of Clinical Nursing, 2014
Aims and objectives. To examine the literature related to a large-scale quality improvement initiative, the 'Productive Ward: Releasing Time to Care', providing a bibliometric profile that tracks the level of interest and scale of roll-out and adoption, discussing the implications for sustainability. Background. Productive Ward: Releasing Time to Care (aka Productive Ward) is probably one of the most ambitious quality improvement efforts engaged by the UK-NHS. Politically and financially supported, its main driver was the NHS Institute for Innovation and Improvement. The NHS institute closed in early 2013 leaving a void of resources, knowledge and expertise. UK roll-out of the initiative is well established and has arguably peaked. International interest in the initiative however continues to develop. Methods. A comprehensive literature review was undertaken to identify the literature related to the Productive Ward and its implementation (January 2006-June 2013). A bibliometric analysis examined/reviewed the trends and identified/measured interest, spread and uptake. Results. Overall distribution patterns identify a declining trend of interest, with reduced numbers of grey literature and evaluation publications. However, detailed examination of the data shows no reduction in peer-reviewed outputs. There is some evidence that international uptake of the initiative continues to generate publications and create interest. Conclusions. Sustaining this initiative in the UK will require re-energising, a new focus and financing. The transition period created by the closure of its creator may well contribute to further reduced levels of interest and publication outputs in the UK. However, international implementation, evaluation and associated publications could serve to attract professional/academic interest in this wellestablished, positively reported, quality improvement initiative. Relevance to clinical practice. This paper provides nurses and ward teams involved in quality improvement programmes with a detailed, current-state, examination and analysis of the Productive Ward literature, highlighting the bibliometric patterns of this large-scale, international, quality improvement programme. It serves to disseminate updated publication information to those in clinical practice who are involved in Productive Ward or a similar quality improvement initiative.