Abstract
BackgroundConcerns about patient safety and reducing harm have led to a particular focus on initiatives that improve healthcare quality. However Quality Improvement (QI) initiatives have in the past typically faltered because they fail to fully engage healthcare professionals, resulting in apathy and resistance amongst this group of key stakeholders. Productive Ward: Releasing Time to Care (PW) is a ward-based QI programme created to help ward-based teams redesign and streamline the way that they work; leaving more time to care for patients. PW is designed to engage and empower ward-based teams to improve the safety, quality and delivery of care.MethodsThe main objective of this study was to explore whether PW sustains the ‘engagement’ of ward-based teams by examining the longitudinal effect that the national QI programme had on the ‘work-engagement’ of ward-based teams in Ireland. Utilising the Utrecht Work Engagement Scale questionnaire (UWES-17), we surveyed nine PW (intervention) sites from typical acute Medical/Surgical, Rehabilitation and Elderly services (representing the entire cohort of a national phase of PW implementation in Ireland) and a cohort of matched control sites. The numbers surveyed from the PW group at T1 (up to 3 months after commencing the programme) totalled 253 ward-team members and 249 from the control group. At T2 (12 months later), the survey was repeated with 233 ward-team members from the PW sites and 236 from the control group.ResultsOverall findings demonstrated that those involved in the QI initiative had higher ‘engagement’ scores at T1 and T2 in comparison to the control group. Total ‘engagement’ score (TES), and its 3 dimensions, were all significantly higher in the PW group at T1, but only the Vigour dimension remained significantly higher at T2 (p = 0.006).ConclusionOur results lend some support to the assertions of the PW initiative itself and suggest that when compared to a control group, ward-based teams involved in the QI programme are more likely to be ‘engaged’ by it and its associated improvement activities and that this is maintained over time. However, only the Vigour dimension of ‘engagement’ remained significantly higher in the PW over time.
Highlights
Concerns about patient safety and reducing harm have led to a particular focus on initiatives that improve healthcare quality
Measuring and comparing the preliminary ‘engagement’ scores from the ward-based teams involved in the national pilot phase of the Productive ward – releasing time to care (PW) and a control group [22], as a baseline measure (T1)
Time one (T1) The initial results obtained at T1 have been reported previously, the main finding being that, controlling for employment grade and specialty, all ‘engagement’ scores at T1 were significantly higher in the PW group compared to the control group [22]
Summary
Concerns about patient safety and reducing harm have led to a particular focus on initiatives that improve healthcare quality. Poor perception and experiences of healthcare from both patients and the media have collectively combined to provide many of the ingredients for a ‘perfect storm’ in healthcare crisis terms This has led to an international call-to-action to ‘rescue’ the provision of healthcare with a particular renewed focus on initiatives that improve the quality of healthcare [1, 2]. The requirement to improve healthcare whilst trying to master what works well and why is very well established; there is a limited understanding of the exact impacts, outcomes and outputs from many of the interventions that are designed to improve healthcare quality This lack of understanding has created an interest amongst researchers and clinicians to articulate what constitutes a successful healthcare QI intervention or initiative [3]
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