Improving the productivity of hospital wards

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

A program called Releasing Time to Care: The Productive Ward has been introduced into 62 public hospital wards in 10 of the 20 District Health Board regions. The program, which was developed in the NHS in England, takes a patient-centered approach to improving the quality of care on acute care nursing units by freeing up caregivers' time for more direct patient care. It gives frontline staff the opportunity to design safer and more reliable care by improving ward processes and environments.

Purpose of health policy or idea

The overall objective of the Productive Ward: Releasing Time to Care program is to enable nurses and other hospital staff to spend more time with patients, thereby improving the safety and efficiency of the ward. The program aims to empower ward teams to identify areas for improvement by giving staff the information, skills and time they need to regain control of their ward and the care they provide. They do this by looking at processes such as drugs rounds, ward rounds and discharges, and then finding ways of streamlining these processes so that the ward staff can spend more time on direct patient care.

Main points

Main objectives

• Increase the proportion of staff time spent with patients
• Improve safety
• Reduce costs and waste
• Improve staff morale

Type of incentives

The incentive to participate in this program stems from the empowerment that staff feel in taking ownership of the problem and finding their own solutions.

Groups affected

Hospital ward staff, hospital patients

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

This program is uncontroversial and is supporrted by both decision-makers and health professionals. It is also not system-dependent, having been developed in England yet successfully implemented in New Zealand. Although the program has fairly low public visibility, the Minister of Health makes a point of bringing some of the positive results being reported in hospitals to the attention of the media.

Political and economic background

Improving productivity in hospitals is an ongoing challenge for all health systems, especially in the current economic environment where public budgets are being squeezed following the world-wide recession. While public spending on health is not being cut in New Zealand, the government is trying to curb its rate of increase. The current government also has a policy of shifting resources into the provision of frontline services.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

This program was developed by the English National Health Service (NHS) Institute for Innovation and Improvement in 2007/2008 and is now operating in all of the acute care trusts in England. In 2008, the NHS invited the New Zealand Ministry of Health to participate in the program and it is now being extended to many other countries. The Productive Ward is part of The Productive Series of programs for improvement and innovation in the NHS. The series adopts efficiency techniques previously used in car manufacturing and safety techniques learned in the aviation industry and applies these techniques to different parts of the health system. 

Initiators of idea/main actors

• Government

• Providers

Approach of idea

The approach of the idea is described as:
renewed: The program was first developed for and introduced in the English NHS in 2007/08.

Stakeholder positions

There are three levels of stakeholders in this program: the Ministry of Health which led the initiative, negotiated adoption of the program with the English NHS and funded the program licences; hospital managers who choose to support the program within their hospital; and ward staff who undergo training, identify problems and suggest solutions. All are very supportive of the program, especially ward staff. For example, one ward manager reported that: "Frontline staff, nurses have found a new passion in organising, working together in teams to eliminate waste, and shaping their work unit into a well organised ward."

Actors and positions

Government
Ministry of Health	very supportive		strongly opposed
Providers
Hospital managers	very supportive		strongly opposed
Ward staff	very supportive		strongly opposed

Influences in policy making and legislation

No legislative change is required to implement the program.

Actors and influence

Government
Ministry of Health	very strong		none
Providers
Hospital managers	very strong		none
Ward staff	very strong		none

Positions and Influences at a glance

Adoption and implementation

Implementation of the program in New Zealand commenced with a pilot being run in two wards in one public hospital. It was soon extended to other wards in the same hospital and is now operating in 62 wards in 10 of the 20 District Health Board regions. Because the program aims to secure permanent change, the implementation process takes time. Once the staff have been trained, a lot of time is spent in collecting data, analysing what is currently happening, and identifying where changes can be made. It can take up to 6 to 12 months for changes to be embedded and for improvements to be seen.

Review mechanisms

Evaluation is ongoing, with individual units monitoring relevant indicators as the program is implemented.

Results of evaluation

Very positive results are being reported from the program, including:

• Nurses are getting back at least 10 per cent of their time to spend on patient care. In some wards, time spent with patients has doubled from around 28% to over 50%
• Cost savings, for example from reduced stock levels and on laundry
• Calmer wards and fewer patient complaints
• Increased patient safety, including reduced medication events
• Improved staff morale
• Barriers broken down between frontline staff and managers between disciplines. 

Expected outcome

This program has been very successful in the UK, especially in reducing medication errors and releasing nursing staff to patient care. Similar outcomes are expected in New Zealand, with early evidence indicating that both the quality and efficiency of services are improving. A similar program, also developed in the NHS, is now being rolled out in operating theatres in New Zealand.  

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

References

Sources of Information

• Ryall, Tony. Extra nursing care for thousands of patients. August 2010. www.beehive.govt.nz/release/extra+nursing+care+thousands+patients+1  
• NHS Institute for Innovation and Improvement. The Productive Ward. www.institute.nhs.uk/quality_and_value/productivity_series/productive_ward.html  
• Ryall, Tony. More productivity in operating theatres. August 2010. www.national.org.nz/Article.aspx?articleId=33736  
• Scoop Independent News. Releasing time to care at North Shore Hospital. November 2008. www.scoop.co.nz/stories/GE0811/S00032.htm  

Author/s and/or contributors to this survey

Toni Ashton, CHSRP

Suggested citation for this online article

Toni Ashton, CHSRP. "Improving the productivity of hospital wards". Health Policy Monitor, October 2010. Available at http://www.hpm.org/survey/nz/a16/2