The Productive Ward: Releasing
Time to Care : A Review of the
Literature for Implementation
TM
Mr. Mark White, HSE/WIT
Professor John Wells, WIT
Emeritus Professor Tony Butterworth University of Lincoln
The Productive Series
The Productive
Community Services
The Productive Ward
The Productive
Leader
The Productive
Community Hospital
The Productive Operating
Theatre
The Productive Mental Health
Ward
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
The Productive Ward aims to turn this...
INDIRECT NURSING TIME
NURSING CARE
DIRECT NURSING TIME
PATIENTS – THE REASON WE EXIST
25 - 40% direct time spent with patients
To this… 60%
INDIRECT NURSING TIME
NURSING CARE
DIRECT NURSING TIME
…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 HSE
National 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.
National Implementation Group
Productive Ward Areas/Sites
Clinical
Programme Rep.
HEI Rep.
4. National Phase 1 Productive Ward Sites
HSE DNE
•Cavan General Hospital
HSE West
•OLOL Drogheda
•Letterkenny General Hospital
•Beaurmont Hospital
•Sligo General Hospital
•Connolly Hospital
•Our Lady’s Manorhamilton
•Roscommon County Hospital
•Ennis General Hospital
•St Johns Hospital Limerick
HSE DML
• St. Vincent’s University Hospital
• Coombe University Hospital
•Midlands Regional Hospital Portlaois
•Midlands Regional Hospital Tullamore
HSE South
•South Infirmary/Victoria
University Hospital
•Cork University Maternity
Hospital
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
Initial search of
Standard Electronic
Databases (Jan 2006
until June 2012).
Key search : Productive
Ward, Productive Series
and Releasing Time to
Care.
Exclusion criteria:
Multiple/Eclectic
initiatives (Lean, TCAB
and tPOT).
318 PW references
210 RTC search theme
Duplicate and nonrelevant removed=109
Potential
74 articles for
consideration.
Inclusion/removal
criteria of
‘Implementation’
‘challenges’
‘lessons learned’
53 relevant articles
Enabling & Empowering
Facilitator & Ward Lead
Roles
A Robust & Engaging
Communication Strategy
Appropriate Training &
Support
Productive Ward
Implementation
A Financial & Human
Resource Committment
Project Planning &
Project Management
Corporate/Management
Engagement & Support
Role of Leadership
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