Article Text

Download PDFPDF

Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the ‘Productive Ward: Releasing Time to Care’ programme in English acute hospitals
  1. Glenn Robert1,
  2. Sophie Sarre1,
  3. Jill Maben2,
  4. Peter Griffiths3,
  5. Rosemary Chable4
  1. 1 Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
  2. 2 School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
  3. 3 Faculty of Health Sciences, University of Southampton, Southampton, UK
  4. 4 Training, Development & Workforce, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Professor Glenn Robert, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London SE1 8WA, UK; glenn.robert{at}


Background 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.

Objective 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.

Design 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.

Results 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.

Conclusions 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.

  • continuous quality improvement
  • healthcare quality improvement
  • implementation science
  • qualitative research
  • quality improvement methodologies

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

View Full Text

Statistics from


  • Contributors GR, JM, PG, RC designed the study. SS carried out the qualitative fieldwork and led the data analysis. GR led the writing of the manuscript. All authors contributed to data analysis, preparation and revision of the final manuscript.

  • Funding This study was funded by the National Institute of Health Research, Health Services and Delivery Research programme (13/157/44).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Health Research Authority London-Stanmore REC (REC reference 16/LO/0918). Local approval was given by the case study sites.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.