Evaluating the Ten Year Impact of the Productive Ward in Clinical Microsystems in English Acute Hospitals: A national study
Objective: to explore the sustained impact of the ‘Productive Ward: Releasing Time to Care’TM programme (PW) in English NHS acute hospitals between 2006 -16.
Background: PW seeks to: improve patient safety and reliability of care; improve patient experience; improve efficiency of care; and improve staff wellbeing. The programme was developed in 2006-08 to give ward staff the tools, skills and time they need in order to implement local improvements.
Methods: two online surveys using open/closed questions: 56/153 (37%) Directors of Nursing (DoNs) in English acute NHS Trusts: 10-item survey with strategic-level questions on hospital use of PW; and 35/57 (61%) identified PW ‘leads’ (PWLs) in English acute NHS Trusts: 22-item survey explored approaches to adoption & implementation, perceptions of the PW programme, and availability of local impact data.
Adoption: most PW-adopting Trusts did so during 2008-9; no Trusts had adopted PW since 2012.
Implementation: typically a phased approach, with goal of implementing in all wards across Trust; full roll-out achieved in 84% of cases; average length of PW use was 3 years (range from >1 year to 7 years); a third of PWLs reported their Trusts collected impact data; quarter of DoNs said impact measures were regularly reported to Trust Board; in 31% of Trusts patients / carers were said to have taken an active role in PW. Current levels of involvement were low.
Assimilation: 69% of DoNs reported PW programme no longer regularly used; change in quality improvement (QI) approach most common reason; although ongoing systematic use of PW rare, PWLs in 97% of Trusts reported at least some elements of PW still used; underlying principles of PW (lean thinking, data display, a role for nursing staff in QI) were taken forward into other QI approaches.
Sustained impact: overall PW impact reported by DoNs and PWLs was positive, although for some specific PW aims (e.g. staff morale) a relatively high proportion noted no impact; although majority of Trusts had abandoned full PW programme in favour of new QI approaches, PW had influenced Trust QI strategy in nearly half; processes resulting from past PW activity still in place (such as protected mealtimes); PW was seen to have led to change through: more efficient and/or standardised routines; the display of information; re-thinking processes; giving staff a voice; and improving staff knowledge and skills.
Sustainability: financial & management support for PW & staff engagement with PW, appear to have declined or disappeared in many Trusts.
Conclusions: significant proportion of Trusts still regularly use some elements of PW a decade after adoption. Regular, systematic use of PW to identify & improve problem areas is uncommon, but legacy of PW principles and some material, processual and spatial impacts (e.g. display of metrics data, standardised patient information boards, protected mealtimes, storage systems) remain evident. Robust quantitative data on local impact of PW over time is lacking in most Trusts.