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Abstract

The progress of the Productive Ward programme has been variable. This article outlines a study that investigated the experience of implementing the programme in different hospitals and the lessons that can be learnt.

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... NHSI & NNRU (2010b) report, a further NNRU (2011) report and commentary in the Management Services Journal (2011) all describe communication as one of the main ingredients for the spread of the Productive Ward. Keeping language simple, while engaging staff was an early implementation message reported by Shepard (2009), suggested by Robert (2011) and echoed in the evaluation report by Gribben et al. (2009). Attempting to ensure that everyone understands the project is identified as an on-going challenge by Svedahl (2009) and is described in more detail by the Health Quality Council's (HQC) (2011) long-term care pilot project report. ...
... Pre-implementation time and planning are prerequisite requirements according to Coutts (2010) who describes the time needed to create and entrench support from all. Clear goals, feasibility and stages of implementation are some of Robert's (2011) checklist items that encourage the spread of Productive Ward. ...
... The chief executive officer (CEO) and senior leadership were able to remove many of the barriers during implementation. Robert (2011) encourages the use of the executive team and existing structures to ensure a strong sense of governance for the spread of the project. Bloodworth (2011) views the need for senior executive commitment as being essential because initiatives such as Productive Ward are about changing the organisation and not just tinkering with systems and making small improvements. ...
Article
AimThis 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 5years 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. EvaluationUsing taxonomic mapping, this paper evaluates the current state of the literature that pertains to Productive Ward implementation experience; success factors; reports, and assessments. Key issuesSeven 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 managementAcknowledging and embracing the seven characteristics during implementation will positively improve the progress and success of the initiatives implementation.
... Productive Ward: RTC is an improvement initiative specifically led by nurses, which has been positively reported, adopted into many NHS organisations (NHS Institute and NNRU, 2010b; a; Robert et al., 2011) and has spread internationally (Farrell and Casey, 2011; Clews, 2013; Davidson, 2011; Coutts, 2010). It was designed and developed by the NHS Institute for Innovation and Improvement (NHSI) in 2005 and it has 3 main aims:  To increase the proportion of time nurses spend in direct patient care,  To improve experience for staff and for patients,  To make structural changes to the use of ward spaces to improve efficiency in terms of time effort and money (NHS Institute and NNRU, 2010b). ...
... After piloting in some large UK NHS trusts in 2006, it was formally launched in 2007, at the Royal College of Nursing Conference. By 2009 it was reported that 40% of all NHS hospitals had purchased some level of NHSI support package (Robert, 2011). International interest in the initiative began in 2008 and continues to grow. ...
... Finally, leadership is reported as one of the fundamental ingredients for a Lean transformational change effort to be successful in a hospital effort (Steed 2012) and the most commonly reported facilitating factor for successful implementation of Productive Ward: RTC is project leadership (Robert et al. 2011). ...
Conference Paper
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Background: Health Services world-wide are continually striving for more cost-effective, improved, quality focused modes and models of care delivery. The Productive Ward: Releasing Time to Care (RTC) is an improvement initiative specifically led by nurses which has been relatively well accepted, adopted and spread internationally. It was designed and developed using improvement principles of ‘Lean Manufacturing’ and formally introduced in Ireland in 2011. Lean and Lean-thinking have their origins in the Toyota Production System. It is a philosophy that loathes waste and strives to eliminate defects and continually attacks both in a never-ending pursuit of perfection. Lean thinking discourages the process of ‘workarounds’ and encourages resolution at the root of the problem. The term ‘Lean Healthcare’ is a relatively new term with a focus on efficiency and patient satisfaction. Aim and objectives: This study reviews the Productive Ward: RTC and Lean Health Care Literature to date, and extracts the reported effects and impacts on employees who engage with it. The study aims to identify key characteristics and investigates the strength of the connection between the two models. Methods: In a systematic review of the literature we searched the published material relating to both Lean healthcare and Productive Ward: RTC, using contemporary nursing and health care journal databases. The literature was then selected using strict systematic inclusion criteria and reviewed. Analysis and Results: The reviewed articles were subjected to a systematic qualitative content analysis to identify key characteristics of reported employee experience, effect and impact. The study identified common and unique employee effects and impacts that exist between Lean-type initiatives in Health Care and the Productive Ward: RTC programme and these are discussed in detail. Recommendations: The themes identified provide insight and impact information to those responsible for implementing improvement initiatives, like Lean or the Productive Ward: RTC, from both a planning and everyday work perspective.
... Within Scotland, the Releasing Time to Care (RTC) programme aims to improve healthcare efficiency and patient experience. One element of RTC is the measurement of direct patient care (DPC), defined as the amount of nursing time spent directly with patients (Robert, 2011). DPC is likely to vary within different healthcare settings, depending on the length and technicality of treatment. ...
Article
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Background Direct patient care is a term used within nursing and healthcare to help quantify and qualify care delivery. Direct patient care time is considered as a valuable measure by healthcare providers to indicate efficiency and to quantify nursing work, however little is understood of the patient experience and care delivery in haemodialysis settings. Aim The aim of this study was to gain an understanding of patients’ and nursing staff perceptions and experiences of ‘direct patient care’ within one haemodialysis unit. Methods A focused ethnographic approach utilised participant observations, informal questioning, photographs and 27 semi-structured interviews of registered nurses, clinical support workers and patients. Observation notes and interviews were transcribed and thematically analysed. Results The key finding was the construction and reconceptualisation of care delivery in this setting. Care was identified to be delivered in two distinct ways, both of which allowed patients to feel cared for. ‘Active care’ where patients feel cared for when they are being dealt with directly by staff and ‘Passive care’ where patients feel cared for through staff availability and visibility. Conclusion Developing this understanding of patient care delivery in this specialism has highlighted some important aspects to the way care can be delivered which challenges current traditional understandings of direct patient care. Time spent with a patient is not the only important consideration to patient experience in haemodialysis. This understanding of passive care could improve care experiences in this setting.
... The programme provides the tools and methods to improve the quality of care at the ward level by encouraging nurses to look at how their ward is organized; and empowering them with the tools and skills to make changes, thus allowing them to spend more time with their patients [30]. Moreover, it encourages clinical nursing teams to take ownership and control of ward-based process improvements whilst instilling a culture of measurement and improvement [31]. One tangible reported output is opportunities for the ward-based team to make structural changes in the use of the ward space and clinical environment to improve efficiency in terms of time, effort and money [32]. ...
Article
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The aim of the study reported in this article was to investigate staff nurses' perceptions and experiences about structural empowerment and perceptions regarding the extent to which structural empowerment supports safe quality patient care. To address the complex needs of patients, staff nurse involvement in clinical and organizational decision-making processes within interdisciplinary care settings is crucial. A qualitative study was conducted using individual semi-structured interviews of 11 staff nurses assigned to medical or surgical units in a 600-bed university hospital in Belgium. During the study period, the hospital was going through an organizational transformation process to move from a classic hierarchical and departmental organizational structure to one that was flat and interdisciplinary. Staff nurses reported experiencing structural empowerment and they were willing to be involved in decision-making processes primarily about patient care within the context of their practice unit. However, participants were not always fully aware of the challenges and the effect of empowerment on their daily practice, the quality of care and patient safety. Ongoing hospital change initiatives supported staff nurses' involvement in decision-making processes for certain matters but for some decisions, a classic hierarchical and departmental process still remained. Nurses perceived relatively high work demands and at times viewed empowerment as presenting additional. Staff nurses recognized the opportunities structural empowerment provided within their daily practice. Nurse managers and unit climate were seen as crucial for success while lack of time and perceived work demands were viewed as barriers to empowerment.
... It was eclectically designed to utilise the best elements of 'Lean' improvement techniques, the intrinsic motivators of social movement theory and the front line engagement theories of large-scale change for QI in a health care environment (NHS Institute and NNRU, 2010b; Robert et al., 2011). UK reports of the initiative have been positive (Gribben et al., 2009;NHS Institute and NNRU, 2010a,b,c;NHS Scotland, 2008), with up to 40% of all NHS hospitals reported to be involved (Robert, 2011). Successful implementation efforts have been reported internationally (Coutts, 2010;Davidson, 2011;van den Broek et al., 2013) adding to a growing body of related peer-reviewed publications and evaluations . ...
Article
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Abstract 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.
Chapter
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.
Article
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The Productive Ward: Releasing Time to Care initiative is probably the largest quality-improvement initiative involving nurses and ward-based teams in the UK and Ireland. The impact of the initiative has been well described, but there has been no robust systematic evaluation of its impact to date. This article reviews the abstracts and conclusions of 30 peer-reviewed articles and nine evaluation reports in relation to outputs, outcomes and impacts, discusses what the Productive Ward has delivered and whether the initiative will be sustained.
Article
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The Productive Ward: Releasing time to care (PW) initiative is predominantly a nurse-led quality improvement (QI) offering, designed to streamline ward work processes and clinical environments in an attempt to 'release time to care'. It has been implemented widely in the UK, recently attracting international interest. This paper systematically reviews the literature relating to the PW initiative, highlights and ranks the reported effects and impacts from a nursing perspective. Nine themes emerged from our content analysis. This paper examines the three most reported themes-empowerment, leadership and engagement-exploring how they may influence the opportunities for implementing and sustaining the initiative. This study brings some experience, learning and insight from the PW initiative to those currently involved in implementation. It also highlights some elements of change not being delivered by PW. The comprehensive list of reported impacts and effects, from a nursing perspective, adds value to senior nurses attempting to cultivate a culture of QI.
Article
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. 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. 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. 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. 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 well-established, positively reported, quality improvement initiative. 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.
Article
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Purpose – This paper reviews the Lean Healthcare and Productive Ward: releasing time to care (RTC) literature and extracts the reported effects and impacts experienced by employees who implement it. The purpose of this paper is to identify and investigate the strength of the connection between the two models and explores the implications for leadership and implementation. Design/methodology/approach – This study reviewed the Lean Healthcare and Productive Ward: RTC literature using strict systematic inclusion criteria. A qualitative content analysis was used to identify key characteristics of reported employee experience, effect or impact. Themes and categories were ranked by the number of citations and presented. Findings – This study outlines the similar employee effects and impacts that exist between Lean-type improvement initiatives and the Productive Ward: RTC programme. It discusses the three top themes of: Empowerment, Leadership and Engagement and explores the opportunities for leadership. It also identifies one key difference between the two initiatives, the socio-cultural effect and impact which is strongly reported with Lean-type improvement initiatives. The socio-cultural element is discussed and presented as one of the fundamental aspects of Lean and the original Toyota production system. Originality/value – This study brings new insights for leaders involved in Lean-type improvement initiatives which are currently being imported into healthcare and provides a comprehensive list of reported employee impacts and effects of value to healthcare leaders attempting to establish an environment and culture of improvement.
Conference Paper
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The Impact that ‘Lean Healthcare’ and the Productive Ward: Releasing Time to Care Initiative has on Employees. A Review of the literature. Background The emphasis in health care is rapidly shifting from a model of low-cost provision to one that embraces low-cost, improvement and high-quality (Mazur, 2012). The Productive Ward: Releasing Time to Care (RTC) is an improvement initiative specifically led by nurses which has been relatively well accepted, adopted (Robert et al., 2011) and spread internationally (Clews, 2013). It was designed and developed using improvement principles of ‘Lean Manufacturing’ and formally introduced in Ireland in 2011. Lean and Lean-thinking have their origins in the Toyota Production System (Womack et al., 1990). It is a philosophy that loathes waste and strives to eliminate defects and continually attacks both in a never-ending pursuit of perfection (Liker, 2004). Lean thinking discourages the process of ‘workarounds’ and encourages resolution at the root of the problem (Womack and Jones, 1998). The term ‘Lean Healthcare’ is a relatively new term with a focus on efficiency and patient satisfaction (de Souza, 2009). Purpose: This paper reviews the Lean Healthcare Productive Ward: Releasing Time to Care (RTC) Literature and extracts the reported effects and impacts on employees who implement it. The study aims to identify and investigate the strength of the connection between the two models and discusses the implications for implementation. Design: This study reviewed the Lean Healthcare and Productive Ward: RTC literature using strict systematic inclusion criteria. A qualitative content analysis was used to identify key characteristics of reported employee experience, effect or impact. Themes and categories were ranked by the number of citations and presented. Findings: This study outlines the similar employee effects and impacts that exist between Lean-type initiatives and the Productive Ward: RTC programme. It discusses and explores the three top themes of: Empowerment, Leadership and Engagement. It also identifies one key difference between the two initiatives, the socio-cultural effect and impact that is well cited in the Lean-type improvement initiatives and poorly reported in the Productive Ward: RTC literature to date. The socio-cultural element is discussed and presented as one of the fundamental aspects of Lean and the original Toyota production system (Radnor et al., 2012; Joosten et al., 2009). Research limitations: Because of the research methods used, the variety of Lean-type methodologies examined, models of implementation reported in the literature and the contextual factors involved in each organisation, these results although valid lack generalisability and can only be applied to the health care sector. Originality/value: This study brings new insights into Lean-type improvement initiatives currently being imported into health care and provides a comprehensive list of reported employee impacts and effects of value to health care leaders involved with introducing or implementing improvement initiatives. References Clews, G. (2013) 'Productive ward goes global', Nursing times.net, (3 May 2011), pp. 1. de Souza, B. L. (2009) 'Trends and approaches in lean healthcare', Leadership in Health Services, 22(2), pp. 121-139. Joosten, T., Bongers, I. and Janssen, R. (2009) 'Application of lean thinking to health care: issues and observations', International Journal for quality in Health Care, 21(5), pp. 341-347. Liker, J. (2004) The toyota Way: 14 Management Principles from the worlds greatest manufacturer., New York: McGraw-Hill. Mazur, L. (2012) 'Facilitating Lean Learning and Behaviors in Hospitals During the Early Stages of Lean Implementation', vol. 24, no. 1 (Mar 2012), p. 11-22( Radnor, Z. J., Holweg, M. and Waring, J. (2012) 'Lean in healthcare: The unfilled promise?', Social Science & Medicine, 74(3), pp. 364-371. Robert, G., Morrow, E., Maben, J., Griffiths, P. and Callard, L. (2011) 'The adoption, local implementation and assimilation into routine nursing practice of a national quality improvement programme: the Productive Ward in England', Journal of Clinical Nursing, 20(7/8), pp. 1196-1207. Womack, J. P. and Jones, D. T. (1998) Lean thinking: banish waste and create wealth in your corporation, London: Touchstone. Womack, J. P., Jones, D. T., Roos, D. and Massachusetts Institute of, T. (1990) 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.
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