School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.
Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK.
BMJ Qual Saf. 2021 Jan;30(1):27-37. doi: 10.1136/bmjqs-2019-009821. Epub 2020 Mar 26.
Improving the quality and efficiency of healthcare is an international priority. A range of complex ward based quality initiatives have been developed over recent years, perhaps the most influential programme has been Productive Ward: Releasing Time to Care. The programme aims to improve work processes and team efficiency with the aim of 'releasing time', which would be used to increase time with patients ultimately improving patient care, although this does not form a specific part of the programme. This study aimed to address this and evaluate the impact using recent methodological advances in complex intervention evaluation design.
The objective of this study was to assess the impact of an augmented version of The Productive Ward: Releasing Time to Care on staff and patient outcomes. The design was a naturalistic stepped-wedge trial. The setting included fifteen wards in two acute hospitals in a Scottish health board region. The intervention was the Productive Ward: Releasing Time to Care augmented with practice development transformational change methods that focused on staff caring behaviours, teamwork and patient feedback. The primary outcomes included nurses' shared philosophy of care, nurse emotional exhaustion, and patient experience of nurse communication. Secondary outcomes covered additional key dimensions of staff and patient experience and outcomes and frequency of emergency admissions for same diagnosis within 6 months of discharge.
We recruited 691 patients, 177 nurses and 14 senior charge nurses. We found statistically significant improvements in two of the study's three primary outcomes: patients' experiences of nurse communication (Effect size=0.15, 95% CI; 0.05 to 0.24), and nurses' shared philosophy of care (Effect size =0.42, 95% CI; 0.14 to 0.70). There were also significant improvements in secondary outcomes: patients' overall rating of ward quality; nurses' positive affect; and items relating to nursing team climate. We found no change in frequency of emergency admissions within six months of discharge.
We found evidence that the augmented version of The Productive Ward: Releasing Time to Care Intervention was successful in improving a number of dimensions of nurse experience and ward culture, in addition to improved patient experience and evaluations of the quality of care received. Despite these positive summary findings across all wards, intervention implementation appeared to vary between wards. By addressing the contextual factors, which may influence these variations, and tailoring some elements of the intervention, it is likely that greater improvements could be achieved.
UKCRN 14195.
提高医疗保健的质量和效率是国际优先事项。近年来，已经开发了一系列复杂的基于病房的质量举措，其中最具影响力的计划可能是富有成效的病房：释放时间以照顾患者。该计划旨在通过改善工作流程和团队效率来“释放时间”，这些时间将用于增加与患者的时间，最终改善患者的护理，尽管这不是该计划的特定部分。本研究旨在解决这一问题，并利用复杂干预评估设计的最新方法学进展来评估其影响。
本研究的目的是评估增强版 Productive Ward: Releasing Time to Care 对员工和患者结果的影响。设计为自然主义的阶梯式楔形试验。该研究设置包括苏格兰卫生委员会地区两家急性医院的 15 个病房。干预措施是 Productive Ward: Releasing Time to Care，辅以关注员工护理行为、团队合作和患者反馈的实践发展变革方法。主要结果包括护士的共同护理理念、护士的情绪耗竭以及患者对护士沟通的体验。次要结果涵盖了员工和患者体验和结果的其他关键维度，以及出院后 6 个月内同一诊断的紧急入院次数。
我们招募了 691 名患者、177 名护士和 14 名高级护士长。我们发现研究的三个主要结果中有两个有统计学意义的改善：患者对护士沟通的体验（效果量=0.15，95%置信区间；0.05 至 0.24），以及护士的共同护理理念（效果量=0.42，95%置信区间；0.14 至 0.70）。次要结果也有显著改善：患者对病房质量的总体评价；护士的积极情绪；以及与护理团队氛围相关的项目。我们没有发现出院后 6 个月内急诊入院次数的变化。
我们有证据表明，增强版 Productive Ward: Releasing Time to Care 干预措施成功地改善了护士体验和病房文化的多个方面，此外还改善了患者体验和对所接受护理质量的评价。尽管所有病房都有这些积极的综合发现，但干预措施的实施似乎在病房之间有所不同。通过解决可能影响这些变化的背景因素，并调整干预措施的一些要素，可能会取得更大的改善。
UKCRN 14195。
