The Productive Ward Program™

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."

Systematic review of interventions to improve nurses’ work environments

“…The use accreditation process significantly reduced intention to leave (p = 0.03) (Aiken et al, 2008), while no significant change was noted from the use of educational approach (Jeon et al, 2018). In contrast, two studies increased intention to leave by using participatory approach which was attributed to additional nurse workload and conflicting priorities (Van Bogaert et al, 2017) and the perceived lack of support from the department, physicians, and senior management in the project team (Schneider et al, 2019). Hence, interpreting the results should consider the potential confounding effects of the study contexts.…”

“…However, one study (Van Bogaert et al, 2017) used participatory approach that led to worse result (p < 0.001). Authors attributed this to the heavy workload experienced by the nurse participants because of the concurrent accreditation process conducted during the implementation period.…”

“…Nurse work environment was measured by eight studies (N = 8, 57.14%) as a holistic concept consisting the dimensions of support received by nurses, competence, relationships, leadership, and autonomy (Aiken, Buchan, Ball, & Rafferty, 2008;Aitken et al, 2011;Calarco, 2011;Gardner et al, 2009;Hall et al, 2008;Jeon et al, 2018;Meraviglia et al, 2009;Van Bogaert et al, 2017). Two studies using participatory approach showed outcome improvement.…”

“…The nurses' positive perception of their job was measured in seven studies (N = 7, 50%). Participatory approach (Aitken et al, 2011;Hall et al, 2008;Schneider, Wehler, & Weigl, 2019;Van Bogaert et al, 2017) and educational strategy (Jeon et al, 2018) failed to improve nurses' satisfaction with their job. However, accreditation process was able to improve job satisfaction (p = 0.008) (Aiken et al, 2008) based on a single-item Likert scale question.…”

“…Studies attributed this result to lack of change in workload (Aiken et al, 2008), higher nurse-to-patient ratio in the study units (Hall et al, 2008), scrutiny of team participation and coordination (Lavoie-Tremblay et al, 2014;Schneider et al, 2019), and increase in participant workload (Van Bogaert et al, 2017).…”