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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