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 % 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 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. 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 Potential 74 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 Leadership Corporate/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