Background 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.
Method 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.
Results 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.
Conclusions 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.
Trial registration number UKCRN 14195.
- stepped-wedge trial
- caring behaviours
- patient experience
- staff experience
- quality improvement
- productive ward
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Presented at An early version of this work was presented at the Royal College of Nursing Research Conference.
Contributors BW led the design and directed the study, developed the Theory of Change logic model and contributed to analysis and interpretation of data. CH contributed to the design of the study, managed study implementation and acquisition of data and contributed to interpretation of data. AE contributed to the study design, and led the statistical analysis and interpretation of data. DB, EASD, MCJ, MM, JER, JC and HS contributed expertise to the study design, data analysis and interpretation. All authors contributed to drafting and revising the article, and final approval of the version for submission.
Funding This article reports independent research funded by the Chief Nurses Directorate, Scottish Government.
Disclaimer The views are those of the authors and not necessarily those of the Scottish Government.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical approval was provided by the East of Scotland Research Ethics Committee (IRAS ID 112898 REC reference 12/ES/0091).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Anonymised data are held securely on University of Dundee computers (Dundee Epidemiology and Biostatistics Unit, DEBU). Data are available upon request but must comply with information governance requirements.
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