Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
BMJ Qual Saf. 2020 Jan;29(1):31-40. doi: 10.1136/bmjqs-2019-009457. Epub 2019 Jul 29.
The 'Productive Ward: Releasing Time to Care' programme is a quality improvement (QI) intervention introduced in English acute hospitals a decade ago to: (1) Increase time nurses spend in direct patient care. (2) Improve safety and reliability of care. (3) Improve experience for staff and patients. (4) Make changes to physical environments to improve efficiency.
To explore how timing of adoption, local implementation strategies and processes of assimilation into day-to-day practice relate to one another and shape any sustained impact and wider legacies of a large-scale QI intervention.
Multiple methods within six hospitals including 88 interviews (with Productive Ward leads, ward staff, Patient and Public Involvement representatives and senior managers), 10 ward manager questionnaires and structured observations on 12 randomly selected wards.
Resource constraints and a managerial desire for standardisation meant that, over time, there was a shift away from the original vision of empowering ward staff to take ownership of Productive Ward towards a range of implementation 'short cuts'. Nonetheless, material legacies (eg, displaying metrics data; storage systems) have remained in place for up to a decade after initial implementation as have some specific practices (eg, protected mealtimes). Variations in timing of adoption, local implementation strategies and contextual changes influenced assimilation into routine practice and subsequent legacies. Productive Ward has informed wider organisational QI strategies that remain in place today and developed lasting QI capabilities among those meaningfully involved in its implementation.
As an ongoing QI approach Productive Ward has not been sustained but has informed contemporary organisational QI practices and strategies. Judgements about the long-term sustainability of QI interventions should consider the evolutionary and adaptive nature of change processes.
“高效病房：释放时间以护理”计划是一项质量改进（QI）干预措施，于十年前在英国急性医院引入，旨在：（1）增加护士直接护理患者的时间。（2）提高护理的安全性和可靠性。（3）改善员工和患者的体验。（4）改变物理环境以提高效率。
探讨采用时机、当地实施策略以及融入日常实践的过程之间如何相互关联，并塑造大规模 QI 干预的任何持续影响和更广泛的遗产。
在六家医院内采用多种方法，包括 88 次访谈（与高效病房负责人、病房工作人员、患者和公众参与代表以及高级管理人员）、10 份病房经理问卷以及对 12 个随机选择的病房进行的结构化观察。
资源限制和管理层对标准化的渴望意味着，随着时间的推移，从最初赋予病房工作人员自主权以采用高效病房的愿景逐渐转向采用一系列实施“捷径”。尽管如此，最初实施后长达十年的时间里，物质遗产（例如，显示指标数据；存储系统）仍然保留，一些特定的实践（例如，保护用餐时间）仍然存在。采用时机、当地实施策略和环境变化的差异影响了融入常规实践和随后的遗产。高效病房为当今仍在实施的更广泛的组织 QI 策略提供了信息，并为那些真正参与其实施的人发展了持久的 QI 能力。
作为一种持续的 QI 方法，高效病房并没有持续下去，但为当代组织 QI 实践和策略提供了信息。关于 QI 干预措施长期可持续性的判断应考虑到变革过程的进化和适应性。
