Evaluation of the impact of an augmented model of The Productive Ward: Releasing Time to Care on staff and patient outcomes: a naturalistic stepped-wedge trial

Abstract

BackgroundImproving the quality and efficiency of healthcare is an international priority. A range of complex ward based quality initiatives have been developed over recent years, perhaps the most influential programme has been Productive Ward: Releasing Time to Care. The programme aims to improve work processes and team efficiency with the aim of ‘releasing time’, which would be used to increase time with patients ultimately improving patient care, although this does not form a specific part of the programme. This study aimed to address this and evaluate the impact using recent methodological advances in complex intervention evaluation design.MethodThe objective of this study was to assess the impact of an augmented version of The Productive Ward: Releasing Time to Care on staff and patient outcomes. The design was a naturalistic stepped-wedge trial. The setting included fifteen wards in two acute hospitals in a Scottish health board region. The intervention was the Productive Ward: Releasing Time to Care augmented with practice development transformational change methods that focused on staff caring behaviours, teamwork and patient feedback. The primary outcomes included nurses’ shared philosophy of care, nurse emotional exhaustion, and patient experience of nurse communication. Secondary outcomes covered additional key dimensions of staff and patient experience and outcomes and frequency of emergency admissions for same diagnosis within 6 months of discharge.ResultsWe recruited 691 patients, 177 nurses and 14 senior charge nurses. We found statistically significant improvements in two of the study’s three primary outcomes: patients’ experiences of nurse communication (Effect size=0.15, 95% CI; 0.05 to 0.24), and nurses’ shared philosophy of care (Effect size =0.42, 95% CI; 0.14 to 0.70). There were also significant improvements in secondary outcomes: patients’ overall rating of ward quality; nurses’ positive affect; and items relating to nursing team climate. We found no change in frequency of emergency admissions within six months of discharge.ConclusionsWe found evidence that the augmented version of The Productive Ward: Releasing Time to Care Intervention was successful in improving a number of dimensions of nurse experience and ward culture, in addition to improved patient experience and evaluations of the quality of care received. Despite these positive summary findings across all wards, intervention implementation appeared to vary between wards. By addressing the contextual factors, which may influence these variations, and tailoring some elements of the intervention, it is likely that greater improvements could be achieved.Trial registration numberUKCRN 14195.

Identifying and understanding benefits associated with return-on-investment from large-scale healthcare Quality Improvement programmes: an integrative systematic literature review

“…Efficiency and productivity enabled managers' abilities to manage, minimise, or reduce costs, and eventually save costs [73,94,[96][97][98]. Systems efficiency helped improve staff efficiency, effectiveness, productivity, and experience, which benefited patients [84,99,100]. Improved systems enabled improved organisational capacity, capability, and resilience [93,[101][102][103][104][105][106].…”

“…MacVane [96] saw QI as a governance tool. Williams et al [100] focused on both staff and patient outcomes. QI was also used to operationalise organisations' strategies [93,108].…”

“…Particularly, some literature reviews and empirical studies reported variable, mixed, or inconclusive results [86,[109][110][111][112][113][114][115], even a decline in quality [99]. A few articles discussed negative unintended outcomes [81,100,104,110,112,114,[116][117][118][119]. de la Perrelle et al [77] noted this lack of reporting of negative findings in their review.…”

How to increase value and reduce waste in research: initial experiences of applying Lean thinking and visual management in research leadership

“… 13 However, this initiative refers to the Lean methods applied in research while the UK National Health Service has improved work processes and team efficiency in an effective system in the Productive Ward with the Releasing Time to Care programme. 22 Lean methods were also applied in the section for animal studies at the Seattle Children Hospital. A daily management system with a work-in-process board achieved up to 17% time reduction in its research sections.…”

“…They found it challenging to make a change in a disseminated national organisation and encouraged running health research systems to focus on continuous improvement 13. However, this initiative refers to the Lean methods applied in research while the UK National Health Service has improved work processes and team efficiency in an effective system in the Productive Ward with the Releasing Time to Care programme 22. Lean methods were also applied in the section for animal studies at the Seattle Children Hospital.…”