The Productive Ward: Releasing Time to Care TM : A Review of the Literature for Implementation Mr. Mark White, HSE/WIT Professor John Wells, WIT Emeritus.

The Productive Ward: Releasing Time to Care TM: A Review of the Literature for

Implementation

Mr. Mark White, HSE/WIT

Professor John Wells, WIT

Emeritus Professor Tony Butterworth University of Lincoln

The Productive Series

The Productive Leader

The Productive Ward

The Productive Mental Health Ward

The Productive Community Hospital

The Productive Community Services

The Productive Operating Theatre

Key Points in Relation to the PW

• Structured, methodical ‘Lean’ approach that focuses on the ward team and the clinical leader

• Analyses the way the ward team works and suggests changes to improve processes

• Makes the environment more user friendly• Highlight KPI’s to demonstrate ‘knowing how we

are doing’ measures• Encourages a culture of continual improvement

PATIENTS – THE REASON WE EXIST

INDIRECT NURSING TIME

DIRECT NURSING TIME

The Productive Ward aims to turn this...

NURSING CARE

25 - 40% direct time spent with patients

INDIRECT NURSING TIME

DIRECT NURSING TIME

NURSING CARE

To this… 60%

…So that both patients and staff benefit

And it looks like this……

2. PW in Ireland

• Designed by NHSi in 2005/2006• Piloted in 2006 & initial roll-out commenced

2007• 2 Early adopter sites in Ireland in 2010:

Roscommon and Cavan• NHSi/WIT Collaboration in early 2010• NHSi/WIT/HSE ‘Improvement and Innovation

Fellowship’ design 2010• ONMSD engagement and national rollout plan

3. Model of Implementation in the HSENational Advisory Group

Chair – ONMSD Director

Director Nursing

Director of Public

Health Nursing

National SIPTU Rep.

National INMO Rep.

National PNA Rep.

National Therapy Leads Rep.

NMPDU Rep.

National PW Rep.

Clinical Program-

me Rep.

HEI Rep.

National Implementation Group

Productive Ward Areas/Sites

4. National Phase 1 Productive Ward Sites

HSE West

•Letterkenny General Hospital

•Sligo General Hospital

•Our Lady’s Manorhamilton

•Roscommon County Hospital

•Ennis General Hospital

•St Johns Hospital Limerick

HSE South

•South Infirmary/Victoria University Hospital

•Cork University Maternity

Hospital

HSE DNE

•Cavan General Hospital

•OLOL Drogheda

•Beaurmont Hospital

•Connolly Hospital

HSE DML

• St. Vincent’s University Hospital

• Coombe University Hospital

•Midlands Regional Hospital Portlaois

•Midlands Regional Hospital Tullamore

HSE South (SE)

•Waterford Regional Hospital

•South Tipperary General Hospital

4. Sites & Site selection Readiness Audit of applicant sites:

• Leadership at Executive level

• Aligned with strategic direction

• Governance of the programme

• Continuous improvement • Capability and knowledge

• Right people in place

Progress

• All 17 sites (23 wards) have completed Module Implementation

• All 23 wards are have completed the 3 foundation modules & commenced process modules

• KHWD data is being Collected on Falls, Unplanned Absenteeisim, Infection Rates

• Preliminary results see improvements in the KHWD data and direct patient care times

(eg. Up to 30 mins/day on handover, 15 mins per dressing, 25mins per discharge, Unplanned Absenteeism from 17 episodes/pm to 1/pm )

Barriers

• Executive buy-in & support• Backfill/Locum replacement• Finance to re-shape/layout the ward• Energy/Motivation to collect Data• Collecting the right data for improvement• Efficient reporting• Release for training and networking

The PW Literature

• 3 NHSi Reports: Lessons for the PW 2010/Learning & Impact Review/Rapid Impact Assessment 2011

• Belfast Evaluation 2008, NHS Scotland 2009• Excellent Nursing Press and grey literature in

the UK and internationally• Peer Reviewed Journals from 2009

Literature Review

Inclusion/removal criteria of

‘Implementation’ ‘challenges’

‘lessons learned’ 53 relevant articles

Duplicate and non-relevant removed=109

Potential74 articles for consideration.

318 PW references 210 RTC search theme

Exclusion criteria: Multiple/Eclectic

initiatives (Lean, TCAB and tPOT).

Key search : Productive Ward, Productive Series and Releasing Time to

Care.

Initial search of Standard Electronic Databases (Jan 2006

until June 2012).

Enabling & Empowering Facilitator & Ward Lead

Roles

Appropriate Training & Support

Project Planning & Project Management

Role of LeadershipCorporate/Management Engagement & Support

A Financial & Human Resource Committment

A Robust & Engaging Communication Strategy

Productive Ward Implementation

Next Steps

Project Implementation• Phase 2 Site recruitment Commenced • Continue with Phase 1 module

implementation.• Improvement metrics and reporting

being refined.• A project implementation evaluation

will take place 2013

Many Thanks…

The Productive Ward: Releasing Time to Care™: What we can Learn from the Literature for Implementation.

In Press

Journal of Nursing Management