The adoption, local implementation and assimilation into routine nursing practice of a national quality improvement programme: the Productive Ward in England

Aim and objective: To explore why innovations in service and delivery are adopted and how they are then successfully implemented and eventually assimilated into routine nursing practice.

Background: The 'Productive Ward' is a national quality improvement programme that aims to engage nursing staff in the implementation of change at ward level.

Design: Mixed methods (analysis of routine data, online survey, interviews) to apply an evidence-based diffusion of innovations framework.

Method: (1) Broad and narrow indicators of the timing of 'decisions to adopt' the Productive Ward were applied. (2) An online survey explored the perceptions of 150 respondents involved with local implementation. (3) Fifty-eight interviews in five organisational case studies to explore the process of assimilation in each context.

Results: Since the launch of the programme in May 2008 staff in approximately 85% of NHS acute hospitals had either downloaded Productive Ward materials or formally purchased a support package (as of March 2009). On a narrower measure, 40% (140) of all NHS hospitals had adopted the programme (i.e. purchased a support package) with large variation between geographical regions. Four key interactions in the diffusion of innovations framework appeared central to the rapid adoption of the programme. Despite widespread perception of significant benefits, frontline nursing staff report that more needs to be carried out to ensure that impact can be demonstrated in quantifiable terms and include patient perspectives.

Conclusions: The programme has been rapidly adopted by NHS hospitals in England. A variety of implementation approaches are being employed, which are likely to have implications for the successful assimilation of the programme into routine nursing practice.

Relevance to clinical practice: This paper summarises the perceived benefits of the Productive Ward programme and highlights important lessons for nurse leaders who are designing (or adapting) and then implementing quality improvement programmes locally, particularly in terms of how to frame such initiatives - and provide support to - ward-level staff.