Table 3

Summary of case study outcomes

Nurse-led discharge (NLD): Premton
The introduction of NLD was under no time pressure, and was developed and audited in an inclusive way that, while coordinated, varied according to each unit’s needs. It was successfully implemented across the units and appeared to be firmly embedded.
Handover at night (HAN): Premton
Everyone agreed HAN was a good idea in principle, but never agreed what the problem was they were trying to solve, nor was the QI leadership clarified, nor was the backing of key senior clinicians forthcoming. Attendance was poor and the project fizzled out, despite an audit showing that it might have been effective in reducing the number of emergency calls from the wards at night.
Enhanced care (EC): Middleswick
The principle and new paperwork were accepted but EC practice was patchy, muddled and challenging. This was exacerbated by mixed messages about the motives for change and staff shortages. When fieldwork ended, the scheme was being redesigned and relaunched alongside wider work on reducing falls.
Postural blood pressure (PBP): Middleswick
PBP measurement struggled to become embedded, with differences between hospitals, but greatest success was on wards with enthusiastic ward managers. Audits of fall incidence were disappointing and a reconfigured team was reconsidering the problem at a wider level, encompassing PBP among other factors.
Managing unprofessional behaviour (MUB): Upsworth
The team leading the innovation had initial problems in designing and implementing MUB locally, taking several months to resolve their internal interdisciplinary differences and difficulties. When fieldwork ended, they were on the way to training a cadre of peer messengers and launching the scheme.
Tissue viability (TV): Upsworth
After auditing, preparation and attempts to train staff on all wards, a small, understaffed QI team launched the new scheme. The message did not percolate to all staff, however, and there was patchy and unsatisfactory practice change with considerable confusion about the new scheme. Following a rethink and the establishment of a fully staffed QI team, matters improved greatly.
  • QI, quality improvement.