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Taylor S, McSherry R, Cook S, Giles E. Exploring the emotional experience of lean. J Health Organ Manag 2020; ahead-of-print. [PMID: 33169587 DOI: 10.1108/jhom-01-2020-0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This research aims to contribute to the literature on Lean implementation in healthcare by studying the emotional experiences of the relevant actors related to a Rapid Process Improvement Workshop (RPIW) in a UK healthcare context. The purpose of this study was to go beyond what people think about Lean and towards an exploration of their subjective, emotional and "feeling" experience and whether that emotional experience influenced Lean implementation. DESIGN/METHODOLOGY/APPROACH A phenomenological and symbolic interactionist qualitative case study was undertaken. Data related to participants' emotional experience were collected through non-participant observation and semi-structured interviews. Data were analysed using thematic network analysis. FINDINGS This paper provides novel insights into the emotional experience of Lean as experienced through an RPIW. The findings reveal that participation in an RPIW is much more than a technical process. It influences how people feel about themselves, is based on relationships with others, and requires mental, physical and emotional effort. All of these factors influence engagement with, initiation of and sustainability of the RPIW. RESEARCH LIMITATIONS/IMPLICATIONS A new conceptual framework for the planning and implementation of RPIWs has been developed. However, because of the chosen research approach, the results may lack generalisability. Therefore, researchers are encouraged to test the framework and proposed practice implications. ORIGINALITY/VALUE Despite emotions being an integral part of individual and social everyday life, emotional experience has not been studied in relation to Lean. This study is the first to explore emotions in relation to Lean, with implications for practice as to how RPIWs are managed with a new framework for implementation being proposed.
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Affiliation(s)
| | | | - Susy Cook
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
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Coles E, Anderson J, Maxwell M, Harris FM, Gray NM, Milner G, MacGillivray S. The influence of contextual factors on healthcare quality improvement initiatives: a realist review. Syst Rev 2020; 9:94. [PMID: 32336290 PMCID: PMC7184709 DOI: 10.1186/s13643-020-01344-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/30/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Recognising the influence of context and the context-sensitive nature of quality improvement (QI) interventions is crucial to implementing effective improvements and successfully replicating them in new settings, yet context is still poorly understood. To address this challenge, it is necessary to capture generalisable knowledge, first to understand which aspects of context are most important to QI and why, and secondly, to explore how these factors can be managed to support healthcare improvement, in terms of implementing successful improvement initiatives, achieving sustainability and scaling interventions. The research question was how and why does context influence quality improvement initiatives in healthcare? METHODS A realist review explored the contextual conditions that influence healthcare improvement. Realist methodology integrates theoretical understanding and stakeholder input with empirical research findings. The review aimed to identify and understand the role of context during the improvement cycle, i.e. planning, implementation, sustainability and transferability; and distil new knowledge to inform the design and development of context-sensitive QI initiatives. We developed a preliminary theory of the influence of context to arrive at a conceptual and theoretical framework. RESULTS Thirty-five studies were included in the review, demonstrating the interaction of key contextual factors across healthcare system levels during the improvement cycle. An evidence-based explanatory theoretical model is proposed to illustrate the interaction between contextual factors, system levels (macro, meso, micro) and the stages of the improvement journey. Findings indicate that the consideration of these contextual factors would enhance the design and delivery of improvement initiatives, across a range of improvement settings. CONCLUSIONS This is the first realist review of context in QI and contributes to a deeper understanding of how context influences quality improvement initiatives. The distillation of key contextual factors offers the potential to inform the design and development of context-sensitive interventions to enhance improvement initiatives and address the challenge of spread and sustainability. Future research should explore the application of our conceptual model to enhance improvement-planning processes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017062135.
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Affiliation(s)
- Emma Coles
- Nursing Midwifery & Allied Health Professions Research Unit (NMAHP-RU), University of Stirling, Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF UK
| | - Julie Anderson
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ UK
| | - Margaret Maxwell
- Nursing Midwifery & Allied Health Professions Research Unit (NMAHP-RU), University of Stirling, Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF UK
| | - Fiona M. Harris
- Nursing Midwifery & Allied Health Professions Research Unit (NMAHP-RU), University of Stirling, Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF UK
| | - Nicola M. Gray
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ UK
| | - Gill Milner
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ UK
| | - Stephen MacGillivray
- School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ UK
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Williams B, Hibberd C, Baldie D, Duncan EAS, Elders A, Maxwell M, Rattray JE, Cowie J, Strachan H, Jones MC. Evaluation of the impact of an augmented model of The Productive Ward: Releasing Time to Care on staff and patient outcomes: a naturalistic stepped-wedge trial. BMJ Qual Saf 2020; 30:27-37. [PMID: 32217699 PMCID: PMC7788216 DOI: 10.1136/bmjqs-2019-009821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/20/2019] [Accepted: 02/27/2020] [Indexed: 11/24/2022]
Abstract
Background Improving the quality and efficiency of healthcare is an international priority. A range of complex ward based quality initiatives have been developed over recent years, perhaps the most influential programme has been Productive Ward: Releasing Time to Care. The programme aims to improve work processes and team efficiency with the aim of ‘releasing time’, which would be used to increase time with patients ultimately improving patient care, although this does not form a specific part of the programme. This study aimed to address this and evaluate the impact using recent methodological advances in complex intervention evaluation design. Method The objective of this study was to assess the impact of an augmented version of The Productive Ward: Releasing Time to Care on staff and patient outcomes. The design was a naturalistic stepped-wedge trial. The setting included fifteen wards in two acute hospitals in a Scottish health board region. The intervention was the Productive Ward: Releasing Time to Care augmented with practice development transformational change methods that focused on staff caring behaviours, teamwork and patient feedback. The primary outcomes included nurses’ shared philosophy of care, nurse emotional exhaustion, and patient experience of nurse communication. Secondary outcomes covered additional key dimensions of staff and patient experience and outcomes and frequency of emergency admissions for same diagnosis within 6 months of discharge. Results We recruited 691 patients, 177 nurses and 14 senior charge nurses. We found statistically significant improvements in two of the study’s three primary outcomes: patients’ experiences of nurse communication (Effect size=0.15, 95% CI; 0.05 to 0.24), and nurses’ shared philosophy of care (Effect size =0.42, 95% CI; 0.14 to 0.70). There were also significant improvements in secondary outcomes: patients’ overall rating of ward quality; nurses’ positive affect; and items relating to nursing team climate. We found no change in frequency of emergency admissions within six months of discharge. Conclusions We found evidence that the augmented version of The Productive Ward: Releasing Time to Care Intervention was successful in improving a number of dimensions of nurse experience and ward culture, in addition to improved patient experience and evaluations of the quality of care received. Despite these positive summary findings across all wards, intervention implementation appeared to vary between wards. By addressing the contextual factors, which may influence these variations, and tailoring some elements of the intervention, it is likely that greater improvements could be achieved. Trial registration number UKCRN 14195.
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Affiliation(s)
- Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Carina Hibberd
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Deborah Baldie
- Division of Nursing, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
| | - Edward A S Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Janice E Rattray
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Julie Cowie
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Heather Strachan
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Martyn C Jones
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
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Udod SA, Duchscher JB, Goodridge D, Rotter T, McGrath P, Hewitt AD. Nurse managers implementing the lean management system: A qualitative study in Western Canada. J Nurs Manag 2020; 28:221-228. [PMID: 31680367 PMCID: PMC7328733 DOI: 10.1111/jonm.12898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
Abstract
AIM This study explores the perceptions and experiences of nurse managers involved in implementing the Lean management system in a Western Canadian province. BACKGROUND The provincial government of Saskatchewan, Canada, implemented a multimillion-dollar investment in the Lean management system to transform health care delivery by reducing waste and increasing efficiency of processes and outcomes. METHODS This qualitative exploratory study employed semi-structured interviews with 14 nurse managers in urban and rural health regions in one Canadian province. RESULTS Six themes outline the difficulties nurse managers experienced in juggling role responsibilities alongside a poorly implemented change system with scarce resources. CONCLUSION The results showed tensions in the implementation of a Lean model adapted in the context of health care organisations. The expectations for nurse managers to be pivotal players in the implementation of transformative health care practices that promote and sustain strategies to reduce waste, improve coordination and increase patient safety require investment in leadership development. IMPLICATIONS FOR NURSING MANAGEMENT Lean management systems significantly impact the roles of nurse managers who require adequate resources and training to successfully adapt. The results of this study may be used for more effective support mechanisms for nurse managers.
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Affiliation(s)
- Sonia A Udod
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Thomas Rotter
- Health Quality Programs, Queen's University, Kingston, ON, Canada
| | - Petrina McGrath
- Quality and Safety, Saskatchewan Health Authority, Saskatoon City Hospital, Saskatoon, SK, Canada
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Sarre S, Maben J, Griffiths P, Chable R, Robert G. The 10-year impact of a ward-level quality improvement intervention in acute hospitals: a multiple methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The ‘Productive Ward: Releasing Time to Care’™ programme (Productive Ward; PW) was introduced in English NHS acute hospitals in 2007 to give ward staff the tools, skills and time needed to implement local improvements to (1) increase the time nurses spend on direct patient care, (2) improve the safety and reliability of care, (3) improve staff and patient experience and (4) make structural changes on wards to improve efficiency. Evidence of whether or not these goals were met and sustained is very limited.
Objective
To explore if PW had a sustained impact over the past decade.
Design
Multiple methods, comprising two online national surveys, six acute trust case studies (including a secondary analysis of local audit data) and telephone interviews.
Data sources
Surveys of 56 directors of nursing and 35 current PW leads; 88 staff and patient and public involvement representative interviews; 10 ward manager questionnaires; structured observations of 12 randomly selected wards and documentary analysis in case studies; and 14 telephone interviews with former PW leads.
Results
Trusts typically adopted PW in 2008–9 on their wards using a phased implementation approach. The average length of PW use was 3 years (range < 1 to 7 years). Financial and management support for PW has disappeared in the majority of trusts. The most commonly cited reason for PW’s cessation was a change in quality improvement (QI) approach. Nonetheless, PW has influenced wider QI strategies in around half of the trusts. Around one-third of trusts had impact data relating specifically to PW; the same proportion did not. Early adopters of PW had access to more resources for supporting implementation. Some elements of local implementation strategies were common. However, there were variations that had consequences for the assimilation of PW into routine practice and, subsequently, for the legacies and sustainability of the programme. In all case study sites, material legacies (e.g. display of metrics data; storage systems) remained, as did some processes (e.g. protected mealtimes). Only one case study site had sufficiently robust data collection systems to allow an objective assessment of PW’s impact; in that site, care processes had improved initially (in terms of patient observations and direct care time). Experience of leading PW had benefited the careers of the majority of interviewees. Starting with little or no QI experience, many went on to work on other initiatives within their trusts, or to work in QI at regional or national level within the NHS or in the private sector.
Limitations
The research draws on participant recall over a lengthy period characterised by evolving QI approaches and system-level change.
Conclusions
Little robust evidence remains of PW leading to a sustained increase in the time nurses spend on direct patient care or improvements in the experiences of staff and/or patients. PW has had a lasting impact on some ward practices. As an ongoing QI approach continually used to make ongoing improvements, PW has not been sustained, but it has informed current organisational QI practices and strategies in many trusts. The design and delivery of future large-scale QI programmes could usefully draw on the lessons learnt from this study of the PW in England over the period 2008–18.
Funding
This National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Sophie Sarre
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | | | - Rosemary Chable
- Training, Development & Workforce, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
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Abstract
BACKGROUND Calculating nurse staffing in the acute hospital has become a key issue but solutions appear distant. Community, mental health and areas such as learning disability nursing have attracted less attention and remain intractable. This review aims to examine current approaches to the issue across many disciplines. DESIGN The approach taken is iterative and in the form of a hermeneutic review. 769 pieces of evidence were reviewed from across disciplines such as nursing, medicine, engineering, statistics, population science, computer science and mathematics where hospital nurse staffing was the subject of the study. RESULTS A number of themes emerged. The first iteration showed the predominance of unit base approaches (eg, nurse numbers, ratios, activity and workload) and the second was the development of methodologies. Subsequent iterations examined issues such as demand, safety, nurse education, turnover, patient outcomes, patient or staff satisfaction, workload and activity. The majority of studies examined (n=767) demonstrated some association between staffing (units or type/skill) and various factors such as staff or patient satisfaction, working conditions, safety parameters, outcomes complexity of work achieved, work left undone or other factors. Many potential areas such as operational safety research were not utilised. CONCLUSION Although the relationship between staffing in acute care and factors such as units, safety or workload is complex, the evidence suggests an interdependent relationship which should only be dismissed with caution. The nature of these relationships should be further examined in order to determine nurse staffing. The body of knowledge appears substantial and complex yet appears to have little impact on policy.
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Affiliation(s)
- Alison Leary
- School of Health and Social Care, London South Bank University, London, UK
- School of Health, University of South Eastern Norway, Oslo, Norway
| | - Geoffrey Punshon
- School of Health and Social Care, London South Bank University, London, UK
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Rakic S, Novakovic B, Stevic S, Niskanovic J. Introduction of safety and quality standards for private health care providers: a case-study from the Republic of Srpska, Bosnia and Herzegovina. Int J Equity Health 2018; 17:92. [PMID: 30286742 PMCID: PMC6172732 DOI: 10.1186/s12939-018-0806-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 06/19/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Regulation of private health care providers (PHPs) in middle-income countries can be challenging. Mandatory safety and quality standards for PHPs have been in place in the Republic of Srpska since 2012, but not all PHPs have adopted them yet. Adoption rates have differed among different types of providers. We studied three predominant types of PHPs to determine why the rate of adoption of the standards varies among them. METHODS This study used a mixed methods approach, which allowed the integration of both quantitative and qualitative data, to develop an explanatory case study. The case study covered three types of private PHPs: pharmacies, dental practices and specialist practices. Primary data were collected through face-to-face semi-structured in-depth interviews and a self-administered postal survey of private health care providers. Our study's theoretical framework was based on the diffusion of innovation theory. RESULTS The rate of adoption of mandatory standards varied among different types of PHP mainly due to four factors: (1) level of concern about negative financial consequences, such as the risk of fines or of losing contracts with the Health Insurance Fund of the Republic of Srpska; (2) availability of information on the standards and implementation process; (3) level of the relevant professional association's support for the introduction of standards; and (4) provider's perceptions of the relevant health chamber's attitude toward the standards. Opinions conveyed to PHPs by peers slightly negatively influenced adoption of the standards at the attitude-forming stage. Perceived gains in professional status did not have a major influence on the decision to adopt standards. All three types of PHPs perceived the same disadvantages of the introduction of safety and quality standards: associated expense, increased administrative burden and disruption of service provision. CONCLUSIONS When introducing mandatory quality and safety standards for PHPs, national health authorities need to: ensure adequate availability of information on the relative advantages of adhering to standards; support the introduction of standards with relevant incentives and penalties; and work in partnership with relevant professional associations and health chambers to get their buy-in for regulation of quality and safety of health services.
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Affiliation(s)
- Severin Rakic
- Public Health Institute of the Republic of Srpska, Jovana Ducica 1, 78000, Banjaluka, Bosnia and Herzegovina.
| | - Budimka Novakovic
- Medical Faculty, University of Novi Sad, Novi Sad, Republic of Serbia
| | - Sinisa Stevic
- Agency for Certification, Accreditation and Healthcare Quality Improvement in the Republic of Srpska, Banjaluka, Bosnia and Herzegovina
| | - Jelena Niskanovic
- Public Health Institute of the Republic of Srpska, Jovana Ducica 1, 78000, Banjaluka, Bosnia and Herzegovina
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Rotter T, Plishka CT, Adegboyega L, Fiander M, Harrison EL, Flynn R, Chan JG, Kinsman L. Lean management in health care: effects on patient outcomes, professional practice, and healthcare systems. Cochrane Database Syst Rev 2017; 2017:CD012831. [PMCID: PMC6486096 DOI: 10.1002/14651858.cd012831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess effects of Lean management in health care on patient, professional, and systems outcomes by addressing the following question. What are the effects of Lean management interventions in health care on patient outcomes, professional practice, and healthcare systems? What are the effects of Lean management interventions in health care on patient outcomes, professional practice, and healthcare systems? To answer the following questions in addressing secondary objectives: What are the effects of Lean management interventions in combination with other management systems (e.g. Six Sigma) on patient outcomes, professional practice, and healthcare systems (utilisation and access, adverse effects, cost)? Is the effectiveness of Lean interventions influenced by the setting (e.g. Emergency Department, Laboratory, Pharmacy) in which they are implemented? What are the effects of Lean management interventions in combination with other management systems (e.g. Six Sigma) on patient outcomes, professional practice, and healthcare systems (utilisation and access, adverse effects, cost)? Is the effectiveness of Lean interventions influenced by the setting (e.g. Emergency Department, Laboratory, Pharmacy) in which they are implemented?
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Affiliation(s)
| | - Christopher T Plishka
- University of SaskatchewanCollege of Pharmacy and NutritionE3315 Health Sciences Building, 104 Clinic PlaceSaskatoonCanadaS7N 5E5
| | - Lawal Adegboyega
- University of SaskatchewanCollege of Pharmacy and NutritionE3315 Health Sciences Building, 104 Clinic PlaceSaskatoonCanadaS7N 5E5
| | | | - Elizabeth L Harrison
- University of SaskatchewanSchool of Physical Therapy, College of MedicineSchool of Physical Therapy, College of MedicineSuite 3400, 3rd Floor, 104 Clinic Place, University of SaskatchewanSaskatoonCanada
| | - Rachel Flynn
- University of AlbertaFaculty of Nursing11405 87 Avenue, level 3, Edmonton Clinic Health AcademyEdmontonCanadaT6G1C9
| | - James G Chan
- University of Northern British ColumbiaSchool of Health SciencesPrince GeorgeCanada
| | - Leigh Kinsman
- University of TasmaniaHealthLaunceston Clinical School, Locked Bag 1377HobartAustralia7250
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Malfait S, Eeckloo K, Van Hecke A. The Influence of Nurses' Demographics on Patient Participation in Hospitals: A Cross-Sectional Study. Worldviews Evid Based Nurs 2017; 14:455-462. [PMID: 28841757 DOI: 10.1111/wvn.12254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient participation is an important issue in contemporary healthcare as it improves quality of care and enhances positive health outcomes. The participation of patients is mainly initiated by the nurses' willingness to share their power and responsibility, but knowledge on nurses' demographic characteristics influencing this behavior is nonexistent. This knowledge is essential to understand and improve patient participation. AIM To determine if nurses' demographic characteristics influence their willingness to engage in patient participation. METHODS A cross-sectional multicenter study in 22 general and three university hospitals with 997 nurses was performed. The Patient Participation Culture Tool for healthcare workers, which measures patient participation behavior, was used. Multilevel analysis, taking into account the difference in wards and hospitals, was used to identify the influence of demographic characteristics. RESULTS A position as supervisor (range: p < .001-.028) and a higher level of education (range: p = <.001-.012) show significant higher scores. Younger nurses seem to be more reluctant in accepting a collaborative patient role (p = .002) and coping with more active patient behavior (p < .001). This new role was less accepted by nurses on geriatric wards (p = .013), who also showed less sharing of information with their patients (p < .001). LINKING EVIDENCE TO ACTION Age and level of education influence nurses' willingness to share power and responsibility with their patients, perhaps indicating that patient participation behavior is an advanced nursing skill and multifaceted interventions, are needed for optimal implementation. Moreover, supervising nurses have different perceptions on patient participation and possibly regard patient participation as an easier task than their team members. This could lead to misunderstandings about the expectations toward patient participation in daily practice, leading to struggles with their nursing staff. Both findings implicate that implementing patient participation on a wide scale is more difficult than expected, which is conflicting with the widespread societal demand for more participation.
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Affiliation(s)
- Simon Malfait
- Nursing researcher, Ghent University Hospital, and Doctoral candidate, Faculty of Medicine and Health Sciences, Department of Public Health, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Kristof Eeckloo
- Professor, Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, and Head of Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium
| | - Ann Van Hecke
- Professor, Faculty of Medicine and Health Sciences, Department of Public Health, University Center for Nursing and Midwifery, Ghent University, and Staff member Nursing Department, Ghent University Hospital, Ghent, Belgium
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10
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White M, Butterworth T, Wells JSG. Reported implementation lessons from a national quality improvement initiative; Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective. J Nurs Manag 2017; 25:519-530. [PMID: 28799269 DOI: 10.1111/jonm.12489] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 11/27/2022]
Abstract
AIM To explore the experiences of participants involved in the implementation of the Productive Ward: Releasing Time to Care™ initiative in Ireland, identifying key implementation lessons. BACKGROUND A large-scale quality improvement programme Productive Ward: Releasing Time to Care™ was introduced nationwide into Ireland in 2011. We captured accounts from ward-based teams in an implementation phase during 2013-14 to explore their experiences. METHODS Semi-structured, in-depth interviews with a purposive sample of 24 members of ward-based teams from nine sites involved in the second national phase of the initiative were conducted. Interviews were analysed and coded under themes, using a seven-stage iterative process. RESULTS The predominant theme identified was associated with the implementation and management of the initiative and included: project management; training; preparation; information and communication; and participant's negative experiences. The most prominent challenge reported related to other competing clinical priorities. CONCLUSIONS Despite the structured approach of Productive Ward: Releasing Time to Care™, it appears that overstretched and busy clinical environments struggle to provide the right climate and context for ward-based teams to engage and interact actively with quality improvement tools, methods and activities. IMPLICATIONS FOR NURSING MANAGEMENT Findings highlight five key aspects of implementation and management that will help facilitate successful adoption of large-scale, ward-based quality improvement programmes such as Productive Ward: Releasing Time to Care™. Utilising pre-existing implementation or quality frameworks to assess each ward/unit for 'readiness' prior to commencing a quality improvement intervention such as Productive Ward: Releasing Time to Care™ should be considered.
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Affiliation(s)
- Mark White
- Programme for Health Service Improvement, Health Services Executive, Dublin, Ireland
| | | | - John S G Wells
- School of Health Science, Waterford Institute of Technology, Waterford, Ireland
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11
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Sari N, Rotter T, Goodridge D, Harrison L, Kinsman L. An economic analysis of a system wide Lean approach: cost estimations for the implementation of Lean in the Saskatchewan healthcare system for 2012-2014. BMC Health Serv Res 2017; 17:523. [PMID: 28774301 PMCID: PMC5543735 DOI: 10.1186/s12913-017-2477-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background The costs of investing in health care reform initiatives to improve quality and safety have been underreported and are often underestimated. This paper reports direct and indirect cost estimates for the initial phase of the province-wide implementation of Lean activities in Saskatchewan, Canada. Methods In order to obtain detailed information about each type of Lean event, as well as the total number of corresponding Lean events, we used the Provincial Kaizen Promotion Office (PKPO) Kaizen database. While the indirect cost of Lean implementation has been estimated using the corresponding wage rate for the event participants, the direct cost has been estimated using the fees paid to the consultant and other relevant expenses. Results The total cost for implementation of Lean over two years (2012–2014), including consultants and new hires, ranged from $44 million CAD to $49.6 million CAD, depending upon the assumptions used. Consultant costs accounted for close to 50% of the total. The estimated cost of Lean events alone ranged from $16 million CAD to $19.5 million CAD, with Rapid Process Improvement Workshops requiring the highest input of resources. Conclusions Recognizing the substantial financial and human investments required to undertake reforms designed to improve quality and contain cost, policy makers must carefully consider whether and how these efforts result in the desired transformations. Evaluation of the outcomes of these investments must be part of the accountability framework, even prior to implementation. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2477-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nazmi Sari
- Department of Economics, University of Saskatchewan, Arts 815, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada.
| | - Thomas Rotter
- College of Pharmacy & Nutrition, University of Saskatchewan, Saskatoon, SK, S7N 5A5, Canada
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Liz Harrison
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Leigh Kinsman
- University of Tasmania and Tasmanian Health Organisation (North), Launceston, TAS, Australia
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12
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Van Bogaert P, Van heusden D, Verspuy M, Wouters K, Slootmans S, Van der Straeten J, Van Aken P, White M. The Productive Ward Program™. Can J Nurs Res 2017; 49:28-38. [DOI: 10.1177/0844562116686491] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim To investigate the impact of the quality improvement program “Productive Ward – Releasing Time to Care™” using nurses’ and midwives’ reports of practice environment, burnout, quality of care, job outcomes, as well as workload, decision latitude, social capital, and engagement. Background Despite the requirement for health systems to improve quality and the proliferation of quality improvement programs designed for healthcare, the empirical evidence supporting large-scale quality improvement programs impacting patient satisfaction, staff engagement, and quality care remains sparse. Method A longitudinal study was performed in a large 600-bed acute care university hospital at two measurement intervals for nurse practice environment, burnout, and quality of care and job outcomes and three measurement intervals for workload, decision latitude, social capital, and engagement between June 2011 and November 2014. Results Positive results were identified in practice environment, decision latitude, and social capital. Less favorable results were identified in relation to perceived workload, emotional exhaustion. and vigor. Moreover, measures of quality of care and job satisfaction were reported less favorably. Conclusion This study highlights the need to further understand how to implement large-scale quality improvement programs so that they integrate with daily practices and promote “quality improvement” as “business as usual.”
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Affiliation(s)
- Peter Van Bogaert
- Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein, Wilrijk, Belgium
- Department of Nursing, Antwerp University Hospital, Wilrijkstraat, Edegem, Belgium
| | - Danny Van heusden
- Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein, Wilrijk, Belgium
- Department of Nursing, Antwerp University Hospital, Wilrijkstraat, Edegem, Belgium
| | - Martijn Verspuy
- Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein, Wilrijk, Belgium
- Department of Nursing, Antwerp University Hospital, Wilrijkstraat, Edegem, Belgium
| | - Kristien Wouters
- Department of Scientific Coordination, University Hospital Antwerp, Wilrijkstraat, Edegem, Belgium
| | - Stijn Slootmans
- Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein, Wilrijk, Belgium
- Department of Nursing, Antwerp University Hospital, Wilrijkstraat, Edegem, Belgium
| | | | - Paul Van Aken
- Antwerp University Hospital, Wilrijkstraat, Edegem, Belgium
| | - Mark White
- System Reform Group, Office of the Director General of the Health Service, HSE Offices, Dublin, Ireland
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13
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Flynn R, Scott SD, Rotter T, Hartfield D. The potential for nurses to contribute to and lead improvement science in health care. J Adv Nurs 2017. [DOI: 10.1111/jan.13164 pmid:27682155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Rachel Flynn
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Shannon D. Scott
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Thomas Rotter
- College of Pharmacy and Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Dawn Hartfield
- Integrated Quality Management, Edmonton Zone; Alberta Health Services; Edmonton Alberta Canada
- Division of Pediatric Hospital Medicine; Department of Pediatrics; Faculty of Medicine and Dentistry; University of Alberta; Edmonton Alberta Canada
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14
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Denis JL, Usher S. Governance Must Dive Into Organizations to Make a Real Difference Comment on "Governance, Government, and the Search for New Provider Models". Int J Health Policy Manag 2017; 6:49-51. [PMID: 28005542 PMCID: PMC5193506 DOI: 10.15171/ijhpm.2016.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/28/2016] [Indexed: 11/09/2022] Open
Abstract
In their 2016 article, Saltman and Duran provide a thoughtful examination of the governance challenges involved in different care delivery models adopted in primary care and hospitals in two European countries. This commentary examines the limited potential of structural changes to achieve real reform and considers that, unless governance arrangements actually succeed in penetrating organizations, they are unlikely to improve care. It proposes three sets of levers influenced by governance that have potential to influence what happens at the point of care: harnessing the autonomy and expertise of professionals at a collective level to work towards better safety and quality; creating enabling contexts for cross-fertilization of clinical and organizational expertise, notably through teamwork; and patient and public engagement to achieve greater agreement on improvement priorities and overcome provider/manager tensions. Good governance provides guidance at a distance but also goes deep enough to influence clinical habits.
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Affiliation(s)
- Jean-Louis Denis
- Canada Research Chair in Governance and Transformation of Health Organizations and Systems, École nationale d'administration publique, Montréal, QC, Canada
| | - Susan Usher
- Health Innovation Forum, Montréal, QC, Canada.,Institute for Strategic Analysis and Innovation, McGill University Health Centre, Montréal, QC, Canada.,École nationale d'administration publique, Montréal, QC, Canada
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15
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Flynn R, Scott SD, Rotter T, Hartfield D. The potential for nurses to contribute to and lead improvement science in health care. J Adv Nurs 2016; 73:97-107. [DOI: 10.1111/jan.13164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Rachel Flynn
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Shannon D. Scott
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Thomas Rotter
- College of Pharmacy and Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Dawn Hartfield
- Integrated Quality Management, Edmonton Zone; Alberta Health Services; Edmonton Alberta Canada
- Division of Pediatric Hospital Medicine; Department of Pediatrics; Faculty of Medicine and Dentistry; University of Alberta; Edmonton Alberta Canada
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16
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Malfait S, Eeckloo K, Van Daele J, Van Hecke A. The Patient Participation Culture Tool for healthcare workers (PaCT-HCW) on general hospital wards: A development and psychometric validation study. Int J Nurs Stud 2016; 61:187-97. [PMID: 27372433 DOI: 10.1016/j.ijnurstu.2016.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/16/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patient participation is an important subject for modern healthcare. In order to improve patient participation on a ward, the ward's culture regarding patient participation should first be measured. In this study a measurement tool for patient participation culture from the healthcare worker's perspective, the Patient Participation Culture Tool for healthcare workers (PaCT-HCW), was developed and psychometrically evaluated. OBJECTIVES The aim of this study was to develop and validate a tool that measures the healthcare worker-related factors of patient participation and information sharing and dialogue in patient participation from the healthcare worker's perspective in order to represent the patient participation culture on general and university hospital wards. DESIGN A four-phased validation study was conducted: (1) defining the construct of the PaCT-HCW, (2) development of the PaCT-HCW, (3) content validation, and (4) psychometric evaluation. SETTINGS The Belgian Federal Government invited all Flemish general and university hospitals by e-mail to distribute the PaCT-HCW in their organization. Fifteen general hospitals took part in the study. PARTICIPANTS Units for surgery, general medicine, medical rehabilitation, geriatric and maternal care were included. Intensive care-units, emergency room-units, psychiatric units and units with no admitted patients (e.g. radiology) were excluded. The respondents had to be caregivers, with hands-on patient contact, who worked on the same ward for more than six months. Nursing students and other healthcare workers with short-time internship on the ward were excluded. The tool was completed by 1329 respondents on 163 wards. METHODS The PaCT-HCW was psychometrically evaluated by use of an exploratory factor analysis and calculation of the internal consistency. RESULTS A model containing eight components was developed through a literature review, individual interviews, and focus interviews. The developed model showed high sampling adequacy and the Bartlett's test of sphericity was significant. An exploratory factor analysis identified eight components, explaining 49.88% of the variances. The eight original included components were retained. The PaCT-HCW also showed high internal consistency. CONCLUSION The PaCT-HCW offers an in-depth and differentiated perspective of the healthcare worker-related factors of patient participation and information sharing and dialogue in patient participation. The PaCT-HCW has been developed thoroughly, resulting in a strong, psychometric evaluated tool and is a valuable measure for both scientists and clinicians to measure these two aspects in general and university hospitals. By using the PaCT-HCW, the opportunity is created to develop specific actions to improve patient participation.
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Affiliation(s)
| | - K Eeckloo
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium; Ghent University Hospital, Belgium.
| | | | - A Van Hecke
- Faculty of Medicine and Health Sciences, Department of Public Health - University Center for Nursing and Midwifery, Ghent University, Belgium; Nursing Department, Ghent University Hospital, Belgium.
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