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Did you know only 30% of quality improvement projects get embedded and are sustained?

  • Comments (3)

In my job as clinical editor I see the latest trends in quality improvement as hospitals quickly implement the latest policy or idea but I often wonder what happens in the long term when the initial fuss has died down? How often do we see a five or ten year follow-up of a nursing innovation?

Take for example productive ward. Last year the NHS Institute which spearheaded the productive ward initiative closed and many nurses wondered what would happen to the valuable knowledge, experience and support they offered. A few weeks ago I can across an interesting paper which identified an apparent declining interest in the initiative in the UK with fewer evaluations being published. 

Does this mean that productive ward has hit the buffers or are trusts continuing to implement the philosophy that underpins this patient-focused innovation but are not publishing the outcomes? I wonder if I walked on a ward today and asked about productive ward would health care professionals describe it as something they did a few years ago when they tidied the cupboards? Would they be able to tell me how it is has continued to develop over time? Or would I just get blank looks?

“The problem is we never really find out what works or why it works”

The same question could be asked about intentional rounding. This initiative was given official backing a few years ago from the prime minister and considerable effort went into its implementation but did it make a difference? Is it still happening?

Considerable investment of time and emotion go into making ideas a reality in busy nursing teams. I am not surprise when nurses become cynical about change when no sooner have they implemented one new idea when policy makers move onto the next thing.

The problem is we never really find out what works or why it works.

What nurses want is change that is going to help them improve care and give them stability. Perhaps it is time to take stock of all the recent quality improvement initiatives in the UK and invest in looking at the long term outcomes because without this information we will continue to go round in circles. If you have been around the health service as long as I have you will know what I mean.

  • Comments (3)

Readers' comments (3)

  • Shortly before I retired last year I had a long conversation with my manager.

    I had 25 odd years experience in CAMHS, had been in that post and location for over a decade; he had no previous experience of CAMHS, nor of the rambling, mostly rural, locality.

    I explained to him why what he wanted us to do in terms of changing the service wouldn't work - we'd tried it about 8 years before and it just didn't fit with the area and our partner organisations - and that we were doing things the way we did for purely pragmatic reasons, like they worked better than anything else we'd tried...

    Didn't want to know; wanted us to get on and do it, thus wasting huge amounts of time and effort trying to make something work which wouldn't...

    'Twas ever thus: get a new manager and they, despite usually knowing less than any of the clinicians, start throwing their weight around, wanting to make a mark, but in reality peeing everyone off and making things worse.

    Or then we have the "flavour of the month" style of NHS management: how many different trends have come and gone over the years because it is the latest fashion? "Essence of Care" anyone? That's been and gone at least twice. The "Tidal Model"? I could go on for hours...

    The main problem is that most of these trends have little or no evidence to back them up, so when the emperor stands naked for all to see he grabs at the nearest vestige of clothing and round we go again...

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  • Anonymous

    Managers usually like to make a mark to show that they are really the person for the job and to give a reason for their salary.
    If something is not broken then leave well alone.
    Managers forget that maintainence and sustainability is more important than trying to change things that do not need changing.

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  • Anonymous

    maybe managers prefer rapid and visible change which is often short term to something more gradual which takes place over time but is far more sustainable. they get more brownie points for the former because they can shout about it and their role in it from the rooftops whereas the latter, although often far more meaningful, may not attract, for them, as much notice. It is a matter of social and professional conscience and which they might prefer to carry with them to their grave!

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