Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the 'Productive Ward: Releasing Time to Care' programme in English acute hospitals.
BACKGROUND
The 'Productive Ward: Releasing Time to Care' programme is a quality improvement (QI) intervention introduced in English acute hospitals a decade ago to: (1) Increase time nurses spend in direct patient care. (2) Improve safety and reliability of care. (3) Improve experience for staff and patients. (4) Make changes to physical environments to improve efficiency.


OBJECTIVE
To explore how timing of adoption, local implementation strategies and processes of assimilation into day-to-day practice relate to one another and shape any sustained impact and wider legacies of a large-scale QI intervention.


DESIGN
Multiple methods within six hospitals including 88 interviews (with Productive Ward leads, ward staff, Patient and Public Involvement representatives and senior managers), 10 ward manager questionnaires and structured observations on 12 randomly selected wards.


RESULTS
Resource constraints and a managerial desire for standardisation meant that, over time, there was a shift away from the original vision of empowering ward staff to take ownership of Productive Ward towards a range of implementation 'short cuts'. Nonetheless, material legacies (eg, displaying metrics data; storage systems) have remained in place for up to a decade after initial implementation as have some specific practices (eg, protected mealtimes). Variations in timing of adoption, local implementation strategies and contextual changes influenced assimilation into routine practice and subsequent legacies. Productive Ward has informed wider organisational QI strategies that remain in place today and developed lasting QI capabilities among those meaningfully involved in its implementation.


CONCLUSIONS
As an ongoing QI approach Productive Ward has not been sustained but has informed contemporary organisational QI practices and strategies. Judgements about the long-term sustainability of QI interventions should consider the evolutionary and adaptive nature of change processes.
['Robert|Glenn|G|0000-0001-8781-6675', 'Sarre|Sophie|S|', 'Maben|Jill|J|', 'Griffiths|Peter|P|', 'Chable|Rosemary|R|']
D003142:Communication D017598:Efficiency, Organizational D019983:Guideline Adherence D006739:Hospital Administration D006801:Humans D007318:Inservice Training D007857:Leadership D008137:Longitudinal Studies D061214:Patient Safety D017410:Practice Guidelines as Topic D017064:Process Assessment, Health Care D058996:Quality Improvement D013222:State Medicine
continuous quality improvement healthcare quality improvement implementation science qualitative research quality improvement methodologies