Exploring the experiences of eight hospitals that have implemented the efficiency scheme
In this article…
- Aims of Productive Ward: Releasing Time to Care
- Experiences of implementing Productive Ward
- Lessons that can be learned from hospitals’ experiences
- Further research needed to enhance the programme
Glenn Robert is a senior research fellow, National Nursing Research Unit, King’s College, London.
Robert G (2011) Progress of the Productive Ward. Nursing Times; 107: 7, early online publication.
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.
Keywords Productive Ward, NHS Institute, Foundation modules, Process modules
- This article has been double-blind peer reviewed
5 key points
- A main aim of the Productive Ward programme is to increase the time nurses spend in direct patient care
- Productive Ward is intended to provide free tools that frontline staff can use to initiate and implement change in wards
- Making structural changes to the use of ward spaces through the programme can improve efficiency
- Since the programme’s launch, staff in approximately 85% of NHS acute hospitals have downloaded Productive Ward materials
- By 2009, 40% of all NHS hospitals had purchased a support package from the NHS Institute to assist with implementation (Robert et al, 2011)
The Productive Ward: Releasing Time to Care programme was introduced in 2005. It was developed through a partnership between the NHS Institute for Innovation and Improvement, nurse leaders, and industry representatives. It was refined through a design process that included working with four test sites in 2006, and with 10 learning partners during 2007-08.
The aim of Productive Ward is to provide tools developed to engage frontline staff in initiating and implementing change at ward level. The free modules and toolkits are available free to NHS organisations and accelerated support packages can be purchased.
Since its formal launch in January 2008, staff in approximately 85% of NHS acute hospitals have downloaded Productive Ward materials from the NHS Institute website (www.institute.nhs.uk/productiveward).
By March 2009, 40% (140) of all NHS hospitals had purchased a support package, albeit with large variations between geographical regions (Robert et al, 2011). NHS hospitals in England have used a variety of methods to implement the programme, which is likely to have implications for its successful assimilation into routine nursing practice.
Recent studies have looked at adoption and spread of Productive Ward (National Nursing Research Unit, 2010a, 2010b).
We need to know more about the experiences and perspectives of organisations and frontline staff who have not yet participated in the programme. These perspectives have the potential to support strategies to deliver its benefits more widely.
For leaders of the Productive Ward in NHS organisations, the aim of my study was to investigate what they could do to help spread the approach, how they could assess whether their organisation was ready to spread the Productive Ward and what actions they should take to overcome barriers to its widespread adoption.
The study was conducted in two phases. Phase 1 comprised: a focused review of the theory relating to the spread of innovations within healthcare, the application of this theory to knowledge of the Productive Ward, and identification of beneficial areas for future research to inform phase two of the study. Phase 2 comprised in-depth case studies in eight purposively sampled NHS organisations from around England that were already implementing the Productive Ward to ascertain the progress they had made by 2010.
The hospital purchased a standard Productive Ward package in October 2008. It received strategic health authority money to implement the programme, which it used to employ two facilitators and to allocate a budget for Productive Ward work.
Progress: Two full-time Productive Ward facilitators are now working with two original wards to re-energise them. A further four wards have come on board. Each ward will be supported for a 12-14 week period.
The hospital purchased an accelerated Productive Ward package in January 2009, and appointed a Productive Ward lead and a support officer.
Progress: Seven wards have done the foundation modules and are beginning to move on to the process modules. The support officer visits wards weekly to remind staff to complete charts and reporting.
Having purchased an accelerated Productive Ward package in June 2008, this hospital arranged for the Productive Ward lead and eight matrons to attend NHS Institute implementation training, which was then taken on to the wards to support them to go through the foundation modules.
Progress: The modules have since been implemented on 19 wards, while six have started on the process modules. A Productive Ward steering group meets monthly to discuss roll-out.
The hospital received funding to purchase an accelerated Productive Ward package. From March 2009, there was no funding left for the Productive Ward facilitator.
Progress: Six wards had completed the three Productive Ward foundation modules and two had done half of the foundation module training when the facilitation stopped. A relaunch day was planned for later in 2010 to involve all levels of staff.
This hospital acquired an accelerated Productive Ward package.Three pilot wards started the programme and the hospital received funding from the SHA. This paid for a full-time practice development nurse for 18 months, and administrative support.
Progress: Productive Ward foundation modules had been implemented on 23 wards, and 16 had started putting the process modules into practice. The priority is for all the wards to receive some form of support as it was uncertain whether the facilitator posts will continue. Wards are expected to do the foundation modules within six months, then are encouraged to start at least two process modules, spending six weeks on each.
This hospital obtained an accelerated Productive Ward package in June 2008.Two matrons implemented the programme across the hospital on top of their existing duties.
Progress: Productive Ward foundation modules are in place on 11 wards and the process modules have been implemented to some extent on a small number of wards. However, implementation has come to a standstill on wards that started the foundation modules. The hospital has appointed new matrons and one is to take on the Productive Ward lead role.
After purchasing an accelerated Productive Ward package, this hospital had a two-year time frame for roll-out across the whole hospital. In 2009, the hospital employed a Productive Ward facilitator and a Productive Ward lead to roll-out the programme across the hospital.
Progress: Two showcase wards have implemented foundation modules and are being left to develop their own way of working. Two other wards have started to implement the foundation modules are and collecting baseline data. The work is monitored and quarterly reports are provided to the programme board and the steering group by the facilitator.
This hospital obtained an accelerated Productive Ward package. From January 2009, five staff worked full-time on the programme for 12 months.
Progress: The Productive Ward Foundation modules have been implemented on all 37 wards and the process modules are in place on six wards.
In the case study sites, multiple participant interviews were used to establish as near as possible an “insider’s” perspective of the context, history, activity, staff and organisational energy, facilitators and barriers, and future plans regarding the Productive Ward.
Learning from experience
I put together a checklist (Box 1) in collaboration with staff from the case study sites to help those leading on the Productive Ward in their hospitals to maintain momentum with its implementation. The suggestions are based around factors found to be most important in the research.
Details of tried and tested tips - based on this checklist - from NHS staff for spreading the Productive Ward in hospitals are available from the NHS Institute for Innovation and Improvement: www.institute.nhs.uk/productiveward
- For further information about the evidence supporting this article see Morrow et al (2010) Improving Healthcare Quality at Scale and Pace. Lessons from The Productive Ward: Releasing time to care. An executive summary and the full report can be accessed at www.institute.nhs.uk/productiveward
National Nursing Research Unit (2010a) Improving Healthcare Quality at Scale and Pace. Lessons fromTheProductive Ward:Releasing Time to Care Programme. Warwick: NHS Institute for Innovation and Improvement.
National Nursing Research Unit (2010b) The Productive Ward: Releasing Time to Care. Learning andImpact Review. Warwick: NHS Institute for Innovation and Improvement.
Robert G et al (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; in press.