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Collaboration to transform care

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A health board and university in North Wales developed a degree module to support the implementation of an improvement initiative


In this article…

  • An overview of Transforming Care
  • Development of a module to support it among managers
  • Collaboration on the module by university and clinical staff


Suzie Wilson is quality and practice development nurse; Rachael Barlow is nurse metrics lead; Diane Read is head of quality for nursing, clinical transformation and leadership; Jean Ryan is clinical librarian; Jill Galvani is director of nursing and patient services; all at Betsi Cadwaladr University Health Board, Gwynedd, Wales



Wilson S et al (2011) Collaboration to transform care. Nursing Times; 107: 27, early online publication.

Transforming Care is an improvement initiative introduced at Betsi Cadwaladr University Health Board in October 2010. The health board collaborated with a university to develop a degree module to support its implementation.

This article describes the delivery and evaluation of the module, and how Transforming Care is helping to unite a newly formed organisation.

Keywords: Transforming care, Improvement, Module

  • This article has been double-blind peer reviewed


5 key points

  • Transforming Care is adapted from the Productive Ward initiative. It aims to improve the patient experience and care outcomes
  • It has three main aims: to reduce adverse events, increase time spent with patients and improve staff and patient satisfaction
  • The Transforming Care module is a 20 credit, level six module for ward leaders involving five study days over four months
  • The module is delivered by university lecturers and senior clinical staff, helping to bridge the gap between theory and practice
  • Bringing together leaders from different clinical settings and places can improve teamwork and enable them to share ideas


A health board in Wales introduced the Transforming Care initiative to improve outcomes and patient experience.

Betsi Cadwaladr University Health Board (BCUHB) is the largest geographical healthcare organisation in the UK, with three acute hospitals, 90 health centres, 121 GP practices and 22 community hospitals serving 676,000 people.

Transforming Care introduces ward teams to the Lean concept, enabling staff to solve everyday problems and focus on care (Graban, 2009). Staff are empowered to implement innovative ideas and develop safe and reliable processes, making working environments calmer and more organised (Eason, 2008).

Transforming Care

Transforming Care is endorsed by the Welsh Assembly Government and led by the National Leadership and Innovation Agency for Healthcare (NLIAH). It is adapted from two successful improvement programmes: Releasing Time to Care: The Productive Ward (NHS Institute for Innovation and Improvement, 2008) and Transforming Care at the Bedside (Institute for Healthcare Improvement, 2003). 

BCUHB collaborated with Glyndwr University to develop a degree module to support the implementation of Transforming Care. The aim was to create a systematic approach to supporting change, and increase the spread and sustainability of the initiative. Transforming Care is expected to be implemented in all clinical areas at BCUHB by July 2012.

Glyndwr University module

The Transforming Care module is a 20 credit, level six module for ward leaders, consisting of five study days over four months. Between 12 and 16 ward managers participate in each module cohort, with a new cohort starting every three months.

This ensures the Transforming Care implementation has a sense of scale and momentum, potentially improving its sustainability and spread (National Nursing Research Unit, 2010).

The sessions introduce clinical leaders to many Productive Ward tools and techniques. The module is assessed by a report, based on an aspect of work identified as requiring further improvement to reduce waste.

Close collaboration between Glyndwr University and BCUHB ensures the module has academic integrity, meets the educational needs of ward managers, and equips them with the practical skills to deliver an improvement programme.

Cohort selection

The first cohort was made up of ward sisters and charge nurses from three acute and two community hospitals. Clinical areas ranged from elderly mental health to acute medical admissions and day surgery.

Ward managers, who were already enthusiastic about the initiative and had already undertaken a leadership programme, made up the first cohort. The aim was to have a number of Transforming Care “showcase” wards with ward managers who would be able to mentor others.

The next cohort will include maternity, outpatients and critical care areas, as well as a 10% intake from the independent sector. Over the next two years all ward managers at BCUHB will take part.

Module delivery

Joint working between the university and clinical setting helps bridge the gap between theory and practice. Lecturers from Glyndwr University provide tuition and academic support; BCUHB Transforming Care facilitators deliver the more practical sessions; and the BCUHB executive nurse team provide support. Guest speakers from local health organisations also provide expertise, and patient representatives share stories.

This joint working is illustrated by the adoption of safety calendars throughout BHUHB. Facilitators promote their use to collect data and to engage and motivate staff to make small improvements.

A safety calendar is displayed on the ward (Fig 1). If an incident occurs, staff colour the date square in red, if not, in green. They are used to measure, for example, pressure ulcers, falls, infection rates and delayed discharges and “days between” incidents. University lecturers explore the theory and psychology of the concept, and why it is a successful improvement tool.

Transforming Care workshops have been held for entire ward teams, including junior doctors, physiotherapists, healthcare assistants and porters. This has encouraged the sharing of ideas between different sites, and helped unite the workforce. Supporting departments, such as complaints, IT, finance and estates, have also engaged with the initiative.


Participants are asked to complete a structured, written evaluation at the end of each study day, and take part in a half day discussion forum near the end of the module.

Forum feedback reflected the importance of bringing together leaders from different clinical settings and locations. This helped dispel organisational myths, such as nurse to patient ratios being higher in one hospital than another, and develop a sense of teamwork. Ideas and innovations were shared and adapted to fit different organisations. One example of this is handover process: one ward was spending up to an hour on each ward handover, while another was taking 15 minutes per ward handover using the SBAR tool (Situation, Background, Assessment  and Recommendation), and a third ward was using voice recorders, which significantly reduced handover time. The shorter handovers were filmed and shared, enabling the teams to adapt their techniques.


Transforming Care is in the early stages at BCUHB, but initial feedback from clinical leaders is promising. It is providing frontline staff with direction, motivation, and inspiration to improve, and helping unite a newly formed organisation.

The collaboration between academics and health board staff has been crucial to delivering a practical, supportive degree module. This could act as a guide for other healthcare organisations undergoing major restructuring, or dealing with extreme financial pressures.

The programme’s success will be determined by the three following aims: a reduction in adverse events; increased time spent with patients; and improved staff and patient satisfaction. These aims are being monitored alongside other quality measures, such as complaints, and will be reported on in the next six to
12 months.

There are also plans for a Transforming Care degree module for staff nurses, and an NVQ module for healthcare assistants.

Box 1. Aims of Transforming Care

Increase time nurses spend on direct care to 70%. The average for England before Productive Ward was 35-40%

Reduce locally defined adverse incidents, for example pressure ulcers, by 50%
Increase patient and staff satisfaction to 95%


Box 2. Module themes

  • Leadership and transforming care: the role of the ward sister
  • Measuring for improvement: meeting and exceeding standards
  • Managing the environment: learning from industry
  • High-quality patient-centred care
  • Transformation and sustaining change


Box 3. staff feedback on module

Assistant director of nursing

“This has embraced nursing staff as part of a change process through strengthened leadership. This is determining the organisation’s direction and performance”

Ward manager, acute medical unit

“Transforming Care is about networking, ideas and inspiration”

Surgical ward manager

“It is moving us towards being one organisation, a way of getting together”

Ward manager, elderly mental health unit

“I wanted to do Transforming Care because nurses felt they weren’t spending enough time with patients… I wanted to make it happen for everybody’s benefit”

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