Improving healthcare quality at scale and pace. Lessons from The Productive Ward: Releasing time to care™ programme. Full report

Abstract

The NHS Institute for Innovation and Improvement’s (NHS Institute) Productive Ward: Releasing time to care™ (The Productive Ward) programme aims to empower ward teams to identify areas for improvement by giving staff the information, skills and time they need to regain control of their ward and the care they provide. This research builds on the insights provided by the NHS Institute’s The Productive Ward: Releasing time to care™, Learning and Impact Review (undertaken February-June 2009), undertaken by the National Nursing Research Unit, Kings College London.
This study (undertaken April-June 2010 by the same research team) aims to inform efforts to maintain momentum of The Productive Ward, to support NHS staff going forward, and to discuss mechanisms and arguments for continued commitment and investment. Broader objectives include; generalising the benefits from this learning, creating a set of hypotheses about the spread of large-scale change that can be tested in future change interventions, theorising about some of the implications for the spread of The Productive Ward and other large-scale change programmes across different sectors of the NHS (eg, mental health, community sectors). What were the aims of the research, what does it tell us and what are we doing about it? It is no secret that the NHS is facing the biggest challenge in its history and that £15-20bn in efficiency savings have to be found by 2014. There are countless examples of money saved and quality improved through using the tools and techniques provided by the NHS Institute’s Productive Series. Some of these can be found at www.institute.nhs.uk/productives. However, we are currently finding that, although The Productive Ward has proved to be extremely successful in the NHS, so far it has been implemented in less than half of the wards in NHS England. This has to represent a huge missed opportunity – and one which needs to be addressed urgently. It is critical that improvement programmes like The Productive Ward which have the potential to have a significant impact on cost and quality are implemented on a large scale and as quickly as possible. To achieve this it is important to understand what is needed to support ‘spread’ and what actions can be taken to overcome potential barriers to widespread adoption, implementation and assimilation of such initiatives into routine practice. The research provides significant insight into a number of questions:

1. What makes some organisations successful and others not in terms of take up?
2. Why do some organisations spread quickly and others do not?
3. What are the timescales that organisations take to spread?
4. Are there organisations that spread quickly and sustain well? What are the characteristics of these
organisations?
5. What is the process that is used in organisations that have spread and sustained well?
6. For organisations that struggle, do they share specific factors?
7. Is it possible to identify specific actions that could overcome barriers?

It also explores how learning from NHS staff experience of implementing The Productive Ward can inform the spread and sustainability of other large scale change initiatives and provides insight into a broader challenge; whether it is possible to take the lessons learnt from The Productive Ward implementation and move from a reactive to proactive understanding of the spread of large-scale change initiatives in a healthcare context.

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Identifiers

ORCID for P. Griffiths: orcid.org/0000-0003-2439-2857

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