White Mark, Butterworth Tony, Wells John Sg
Director, Nursing and Midwifery Planning and Development Unit, Office Complex, Kilcreene Hospital, Kilkenny, R95 DK07, Ireland.
Emeritus Professor of Healthcare Workforce Innovation, University of Lincoln, Lincoln, UK.
BMC Health Serv Res. 2017 Aug 1;17(1):510. doi: 10.1186/s12913-017-2446-2.
Concerns about patient safety and reducing harm have led to a particular focus on initiatives that improve healthcare quality. However Quality Improvement (QI) initiatives have in the past typically faltered because they fail to fully engage healthcare professionals, resulting in apathy and resistance amongst this group of key stakeholders. Productive Ward: Releasing Time to Care (PW) is a ward-based QI programme created to help ward-based teams redesign and streamline the way that they work; leaving more time to care for patients. PW is designed to engage and empower ward-based teams to improve the safety, quality and delivery of care.
The main objective of this study was to explore whether PW sustains the 'engagement' of ward-based teams by examining the longitudinal effect that the national QI programme had on the 'work-engagement' of ward-based teams in Ireland. Utilising the Utrecht Work Engagement Scale questionnaire (UWES-17), we surveyed nine PW (intervention) sites from typical acute Medical/Surgical, Rehabilitation and Elderly services (representing the entire cohort of a national phase of PW implementation in Ireland) and a cohort of matched control sites. The numbers surveyed from the PW group at T1 (up to 3 months after commencing the programme) totalled 253 ward-team members and 249 from the control group. At T2 (12 months later), the survey was repeated with 233 ward-team members from the PW sites and 236 from the control group.
Overall findings demonstrated that those involved in the QI initiative had higher 'engagement' scores at T1 and T2 in comparison to the control group. Total 'engagement' score (TES), and its 3 dimensions, were all significantly higher in the PW group at T1, but only the Vigour dimension remained significantly higher at T2 (p = 0.006).
Our results lend some support to the assertions of the PW initiative itself and suggest that when compared to a control group, ward-based teams involved in the QI programme are more likely to be 'engaged' by it and its associated improvement activities and that this is maintained over time. However, only the Vigour dimension of 'engagement' remained significantly higher in the PW over time.
对患者安全和减少伤害的担忧促使人们特别关注那些提高医疗质量的举措。然而，过去质量改进（QI）举措通常难以取得成效，因为它们未能充分调动医疗专业人员的积极性，导致这一关键利益相关群体出现冷漠和抵触情绪。高效病房：释放护理时间（PW）是一项基于病房的QI项目，旨在帮助病房团队重新设计并简化工作方式，从而留出更多时间照顾患者。PW旨在促使并赋能病房团队，以提高护理的安全性、质量和服务水平。
本研究的主要目的是通过考察国家QI项目对爱尔兰病房团队“工作投入度”的纵向影响，来探究PW是否能维持病房团队的“投入度”。我们使用乌得勒支工作投入量表问卷（UWES - 17），对来自典型急性内科/外科、康复和老年服务科室的9个PW（干预）站点（代表爱尔兰全国PW实施阶段的整个队列）以及一组匹配的对照站点进行了调查。在T1（项目开始后长达3个月）时，PW组参与调查的共有253名病房团队成员，对照组有249名。在T2（12个月后），对PW站点的233名病房团队成员和对照组的236名成员再次进行了调查。
总体研究结果表明，与对照组相比，参与QI举措的人员在T1和T2时的“投入度”得分更高。PW组在T1时的总“投入度”得分（TES）及其3个维度均显著更高，但在T2时只有活力维度仍显著更高（p = 0.006）。
我们的结果为PW举措本身的论断提供了一些支持，并表明与对照组相比，参与QI项目的病房团队更有可能被该项目及其相关改进活动所“吸引”，且这种情况会随着时间持续存在。然而，随着时间推移，PW组中只有“投入度”的活力维度仍显著更高。
