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Productive Ward: Releasing Time to Care™ (A Ward-Based QI Intervention)

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The Organizational Context of Nursing Practice

Abstract

The Productive Ward: Releasing Time to Care™ initiative has most arguably been the largest scale quality improvement initiative involving nurses and ward-based teams in the UK and Europe in recent years. One of its main aims is to increase the proportion of time nurses spend in direct patient care. Reports of the initiative and its influences have been well described. Robust, systematic evaluations of the initiative and its impact continue but remain sparse. This chapter comprehensively reviews 36 peer-reviewed papers and 9 evaluation reports in terms of outputs, outcomes and impacts. It discusses achievements of Productive Ward: Releasing Time to Care™, some of the unintended consequences that have been reported, the role of context and conditions that influence implementation and indications of how the initiative can be sustained. As quality improvement initiatives go, Productive Ward: Releasing Time to Care™ is now relatively mature (more than 12 years of experience), and its popularity and appeal may well have peaked. The future of Productive Ward: Releasing Time to Care™ will depend on the intentions of its current licensor and decisions at the many sites that commenced the initiative and/or adapted it into their larger quality improvement programmes.

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References

  • Allsopp P, Faruqi J, Gascoigne L, Tennyson R. Productive Ward 2: practical advice to facilitators implementing the programme. Nurs Times. 2009;105(25):19–21.

    PubMed  Google Scholar 

  • Armitage C, Hingham P. The Productive Ward: encouraging teambuilding and innovation. Nurs Manag. 2011;18(1):28–31.

    Article  Google Scholar 

  • Avis K. Releasing time to care in Saskatchewan: promising signs that programme engages clinicians. Saskatoon: Health Quality Council; 2009.

    Google Scholar 

  • Avis K. Looking Back Thinking forward; Insight and recommendations from health region leadership on creating a culture of continuous performance in Saskatchewan. Saskatoon: Health Quality Council. 2011.

    Google Scholar 

  • Bate P, Mendel P, Robert GB. Organizing for quality: the improvement journeys of leading hospitals in Europe and the United States. Oxford: Radcliffe Publishing. 2008.

    Google Scholar 

  • Blakemore S. How Productive Wards can improve patient care. Nurs Manag. 2009;16(5):14–8.

    Article  Google Scholar 

  • Bloodworth K. Productive Ward. 1: implementing the initiative across a large university teaching hospital. Nurs Times. 2009;105(24):22–5.

    PubMed  Google Scholar 

  • Bloodworth K. The Productive Ward and the productive operating theatre. J Perioper Pract. 2011;21(3):97–103.

    Article  PubMed  Google Scholar 

  • Brunoro-Kadash C, Kadash N. Time to care: a patient-centered quality improvement strategy. Leadersh Health Serv. 2013;26(3):220–31.

    Article  Google Scholar 

  • Burgess N, Radnor Z. Evaluating lean in healthcare. Int J Health Care Qual Assur. 2013;26(3):220–35.

    Article  PubMed  Google Scholar 

  • Burston S, Chaboyer W, Wallis M, Stanfield J. A discussion of approaches to transforming care: contemporary strategies to improve patient safety. J Adv Nurs. 2011;67(11):2488–95.

    Article  PubMed  Google Scholar 

  • Charles RG, Kathleen LM, Sriranjita S. Contrasting continuous quality improvement, Six Sigma, and lean management for enhanced outcomes in US hospitals. Am J Bus. 2012;27(2):133–53.

    Article  Google Scholar 

  • Clarke U, Marks-Maran D. Nurse leadership in sustaining programmes of change. Br J Nurs. 2014;23(4):219–24.

    Article  PubMed  Google Scholar 

  • Coutts J. Releasing time to care. Healthc Q. 2010;13(2):21–3.

    Article  PubMed  Google Scholar 

  • Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50.

    Article  PubMed  PubMed Central  Google Scholar 

  • Davies H, Powell A, Rushmer R. Why don’t clinicians engage with quality improvement? J Health Serv Res Policy. 2007;12(3):129–30.

    Article  PubMed  Google Scholar 

  • Davis J, Adams J. The ‘releasing time to care - the Productive Ward’ programme: participants’ perspectives. J Nurs Manag. 2012;20(3):354–60.

    Article  PubMed  Google Scholar 

  • Deming WE. Out of the crisis: quality, productivity and competitive position. Cambridge: Cambridge University Press; 1986.

    Google Scholar 

  • Dixon-Woods M, McNicol S, Martin G. Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant literature. BMJ Qual Saf. 2012;21(10):876–84.

    Article  PubMed  PubMed Central  Google Scholar 

  • Feigenbaum AV. Total quality control. New York: McGraw-Hill; 1983.

    Google Scholar 

  • Ferlie EB, Shortell SM. Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q. 2001;79(2):281–315.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Fixsen DL, Naoom SF, Blase KA, Fiedman RM, Wallace F. Implementation research: a synthesis of the literature. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute; 2005.

    Google Scholar 

  • Foley B, Cox A. Work organisation and innovation: case study: Nottingham University Hospitals NHS Trust, UK. Dublin: European Foundation for the Improvement of Living and Working Conditions; 2013.

    Google Scholar 

  • Foster S, Gordon P, McSherry W. Rolling out Productive Ward foundation modules across a hospital trust. Nurs Times. 2009;105(30-31):28–30.

    PubMed  Google Scholar 

  • Gill D, Mountford J, Arasaratnam R. What is a quality improvement project? Br J Hosp Med. 2012;73(5):252–6.

    Article  Google Scholar 

  • Glasgow JM, Davies ML, Kaboli PJ. Findings from a national improvement collaborative: are improvements sustained? BMJ Qual Saf. 2012;21(8):663–9.

    Article  PubMed  Google Scholar 

  • Gollop R, Whitby E, Buchanan D, Ketley D. Influencing sceptical staff to become supporters of service improvement: a qualitative study of doctors’ and managers’ views. Qual Saf Health Care. 2004;13(2):108–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Graban M. Lean hospitals; improving quality, patient safety, and employee engagement. 2nd ed. New York: CRC Press; 2012.

    Google Scholar 

  • Grant P. The Productive Ward round: a critical analysis of organisational change. Int J Clin Leadership. 2008;16(4):193–201.

    Google Scholar 

  • Gribben B, McCance T, Slater P. Belfast health and social care trust, Productive Ward-releasing time to care evaluation report. Belfast: BHSCT; 2009.

    Google Scholar 

  • Hamilton J, Verrall T, Maben J, Griffiths P, Avis K, Baker GR, Teare G. One size does not fit all: a qualitative content analysis of the importance of existing quality improvement capacity in the implementation of releasing time to care: the Productive Ward™ in Saskatchewan, Canada. BMC Health Serv Res. 2014;14(1):1–14.

    Article  CAS  Google Scholar 

  • Harvey G, Kitson A. PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice. Implement Sci. 2016;11(1):33.

    Article  PubMed  PubMed Central  Google Scholar 

  • Havelock RG. The change agent’s guide to innovation in education. Englewood Cliffs: Educational Technology Publications; 1973.

    Google Scholar 

  • Health Quality Council. Releasing time to care: the Productive Ward long-term care pilot project report. Saskatoon: Health Quality Council; 2011.

    Google Scholar 

  • Juran JM, Gryna FM. Juran’s quality control handbook. London: McGraw-Hill; 1988.

    Google Scholar 

  • Kemp P, Merchant S. How to turn innovations into everyday practice. Ment Health Pract. 2011;15(2):20–4.

    Article  Google Scholar 

  • Kenett RS. Lean six sigma for hospitals: strategic steps to fast, affordable. Flawless Healthcare. 2011;44(11):62–3.

    Google Scholar 

  • Langley G, Nolan K, Norman C, Provost L, Nolan T. The improvement guide: a practical approach to enhancing organizational performance. 2nd ed. San Francisco: Jossey-Bass; 2009.

    Google Scholar 

  • Lennard C. How the Productive Ward scheme gives staff more time to care: implementation of a work efficiency initiative in an acute mental health adult ward is improving nurses’ welfare while providing a more effective service to clients. Ment Health Pract. 2012;15(5):30.

    Article  Google Scholar 

  • Lennard C. Productive Ward initiative promotes better communication between mental health teams and ensures timely discharge for patients. J Psychiatr Ment Health Nurs. 2014;21(1):4.

    Article  Google Scholar 

  • Mazzocato P, Savage C, Brommels M, Aronsson H, Thor J. Lean thinking in healthcare: a realist review of the literature. Qual Saf Health Care. 2010;19(5):376–82.

    PubMed  Google Scholar 

  • Moore D, Blick G, Leggott J, Bloodworth K. Assessment of the implementation of the Productive Ward and Productive Operating Theatre programmes in New Zealand. Wellington: Sapere Research Group; 2013.

    Google Scholar 

  • Morrow E, Robert G. Exploring the nature and impact of leadership on the local implementation of the Productive Ward releasing time to care. J Health Organ Manag. 2014;28(2):154–76.

    Article  PubMed  Google Scholar 

  • Morrow E, Robert G, Maben J, Griffiths P. Implementing large-scale quality improvement: lessons from The Productive Ward: Releasing Time to Care. Int J Health Care Qual Assur. 2012;25(4):237–53.

    Article  PubMed  Google Scholar 

  • Mountford J, Shojania KG. Refocusing quality measurement to best support quality improvement: local ownership of quality measurement by clinicians. BMJ Qual Saf. 2012;21(6):519–23.

    Article  PubMed  Google Scholar 

  • NHS Institute and NNRU. Improving healthcare quality at scale and pace, lessons for the Productive Ward: Releasing Time to Care programme. Warwick: NHS Institute; 2010a.

    Google Scholar 

  • NHS Institute and NNRU. The Productive Ward: Releasing Time to Care learning and impact review. Warwick: NHS Institute; 2010b.

    Google Scholar 

  • NHS Scotland. NHS Scotland, releasing time to care evaluation. Edinburgh: NHS Scotland; 2008.

    Google Scholar 

  • Nursing Standard. Full roll-out for Productive Wards by 2013. Nurs Stand. 2012;26(19):7.

    Google Scholar 

  • Ovretveit J. Understanding the conditions for improvement: research to discover which context influences affect improvement success. BMJ Qual Saf. 2011;20(Supplement 1):i18–23.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ovretveit J. Contemporary quality improvement. Cad Saude Publica. 2013;29(3):424–6.

    Article  PubMed  Google Scholar 

  • Pressman JL, Wildavsky AB. Implementation: how great expectation in Washington are dashed in Oakland; or, why it’s amazing that federal programs work at all, this being a saga of the economic development administration as told by two sympathetic observers who seek to build morals on a foundation. Berkeley: University California Press; 1973.

    Google Scholar 

  • QIPP-NHS Evidence. The Productive Ward - quality and productivity example; 2009.

    Google Scholar 

  • Reay T, Hinings CR. Managing the rivalry of competing institutional logics. Organ Stud. 2009;30(6):629–52.

    Article  Google Scholar 

  • Robert G. Progress of the Productive Ward. Nurs Times. 2011;107(7):18–9.

    PubMed  Google Scholar 

  • Robert G, Morrow E, Maben J, Griffiths P, Callard L. The adoption, local implementation and assimilation into routine nursing practice of a national quality improvement programme: the Productive Ward in England. J Clin Nurs. 2011;20(7-8):1196–207.

    Article  PubMed  Google Scholar 

  • Rudge T. Desiring productivity: nary a wasted moment, never a missed step. Nurs Philos. 2013;14(3):201–11.

    Article  PubMed  Google Scholar 

  • Scotland N. Releasing time to care: making our priorities possible—final report. Edinburgh: NHS; 2013.

    Google Scholar 

  • Siriwardena AN. Engaging clinicians in quality improvement initiatives: art or science? Qual Prim Care. 2009;17(5):303–5.

    PubMed  Google Scholar 

  • Smith J, Rudd C. Implementing the Productive Ward Management programme. Nurs Stand. 2010;24(31):45–8.

    Article  PubMed  Google Scholar 

  • Taitz JM, Lee TH, Sequist TD. A framework for engaging physicians in quality and safety. BMJ Qual Saf. 2012;21(9):722–8.

    Article  PubMed  Google Scholar 

  • The Health Foundation. Evidence scan: improvement science. London: The Health Foundation; 2011.

    Google Scholar 

  • Van Bogaert P, Van heusden D, Somers A, Tegenbos M, Wouters K, Van der Straeten J, Van Aken P, Havens DS. The Productive Ward Program™: a longitudinal multilevel study of nurse perceived practice environment, burnout, and nurse-reported quality of care and job outcomes. JONA. 2014;44(9):452–61.

    Article  Google Scholar 

  • Van Bogaert P, Van heusden D, Verspuy M, Wouters K, Slootmans S, Van der Straeten J, Van Aken P, White M. The Productive Ward Program™: a two-year implementation impact review using a longitudinal multilevel study. Can J Nurs Res. 2017;49:28–38.

    Article  PubMed  Google Scholar 

  • van den Broek J, Boselie P, Paauwe J. Multiple institutional logics in health care: Productive Ward: ‘releasing time to care’. Public Manage Rev. 2013;16(1):1–20.

    Article  Google Scholar 

  • van Os A, de Gilder D, van Dyck C, Groenewegen P. Responses to professional identity threat. J Health Organ Manag. 2015;29(7):1011–28.

    Article  PubMed  Google Scholar 

  • White M. How effective is Productive Ward. Nurs Times. 2015;111(11):12–4.

    Google Scholar 

  • White M, Butterworth T, Wells JS. Healthcare quality improvement and ‘work engagement’; concluding results from a national, longitudinal, cross-sectional study of the ‘Productive Ward-Releasing time to care’ programme. BMC Health Serv Res. 2017a;17(510):1–11.

    Google Scholar 

  • White M, Butterworth T, Wells JSG. Reported implementation lessons from a national quality improvement initiative; Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective. J Nurs Manag. 2017b;25(7):519–30. https://doi.org/10.1111/jonm.12489.

    Article  PubMed  Google Scholar 

  • White M, Butterworth T, Wells JSG. Productive Ward: Releasing Time to Care, or capacity for compassion: results from a longitudinal study of the quality improvement initiative. J Res Nurs. 2017c;22(1/2):91–109.

    Article  Google Scholar 

  • White M, Waldron M. Effects and impacts of Productive Ward from a nursing perspective. Br J Nurs. 2014;23(8):419–26.

    Article  PubMed  Google Scholar 

  • White M, Wells JGS, Butterworth T. Leadership, a key element of quality improvement in healthcare. Results from a literature review of ‘Lean-Healthcare’ and the Productive-Ward: Releasing-Time-to-Care Initiative. Int J Leadership Public Serv. 2013;9(3/4):1–22.

    Google Scholar 

  • White M, Wells JS, Butterworth T. The transition of a large-scale quality improvement initiative: a bibliometric analysis of the Productive Ward: Releasing Time to Care programme. J Clin Nurs. 2014a;23(17–18):2414–23.

    Article  PubMed  Google Scholar 

  • White M, Wells JSG, Butterworth T. The impact of a large-scale quality improvement programme on work engagement: preliminary results from a national cross-sectional-survey of the ‘Productive Ward’. Int J Nurs Stud. 2014b;51(12):1634–43.

    Article  PubMed  Google Scholar 

  • White M, Wells JSG, Butterworth T. The Productive Ward: Releasing Time to Care™ – what we can learn from the literature for implementation. J Nurs Manag. 2014c;22(7):914–23. https://doi.org/10.1111/jonm.12069.

    Article  PubMed  Google Scholar 

  • Wilson G. Implementation of releasing time to care – the Productive Ward. J Nurs Manag. 2009;17(5):647–54.

    Article  PubMed  Google Scholar 

  • Womack JP, Jones DT, Roos D, Massachusetts Institute of Technology. The machine that changed the world: based on the Massachusetts Institute of Technology 5-million dollar 5-year study on the future of the automobile. New York: Rawson Associates; 1990.

    Google Scholar 

  • Wright S, McSherry W. A systematic literature review of Releasing Time to Care: The Productive Ward. J Clin Nurs. 2013a;22(9-10):1361–71.

    Article  PubMed  Google Scholar 

  • Wright S, McSherry W. How much time do nurses spend on patient care? Nurs Times. 2013b;109.

    Google Scholar 

  • Wright S, McSherry W. Evaluating the Productive Ward at an acute NHS trust: experiences and implications of releasing time to care. J Clin Nurs. 2014;23(13–14):1866–76.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Nursing and Midwifery Planning and Development Unit, HSE South, Kilkenny, Ireland

    Mark White

  2. School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland

    Mark White

  3. Faculty of Nursing, Royal College of Surgeons, Dublin, Ireland

    Mark White

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Correspondence to Mark White .

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Editors and Affiliations

  1. Nursing and Midwifery Sciences, Centre for Research and Innovation in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

    Peter Van Bogaert

  2. William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA

    Sean Clarke

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White, M. (2018). Productive Ward: Releasing Time to Care™ (A Ward-Based QI Intervention). In: Van Bogaert, P., Clarke, S. (eds) The Organizational Context of Nursing Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-71042-6_5

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  • DOI: https://doi.org/10.1007/978-3-319-71042-6_5

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