Frontline staff will be able to devise their own strategies for spending more time with patients under productive ward. Alexis Nolan reports

Foundations are crucial for success. What might appear the simplest projects can be doomed to failure without the right building blocks in place from the beginning.

The Productive Ward programme is no different. The concept is disarmingly straightforward: empower frontline staff to improve ward-based systems and processes so that they can spend less time on wasted activity and more time on direct patient care.

Few would argue with the concept but the fact that so many nurses, therapists and healthcare assistants spend so little time on direct patient care - as little as 25 per cent - shows that improving the situation is easier said than done.

The NHS Institute for Innovation and Improvement's Productive Ward programme has been in development for more than a year, learning from the experiences of four test sites and more recently 10 learning partners and two whole hospital sites. This activity will soon yield fruit for the wider NHS. From the end of January next year the institute will begin the release of 15 modules which trusts will be able to use to drive ward-based improvement.

Five for the future

Five of the 15 modules should form the foundations for organisations adopting Productive Ward:

Trust start-up kit What an organisation needs to commit, how it prepares to start and how the organisation chooses where to start;

Ward start-up kit What your ward needs to do to get ready;

Knowing how we are doing Developing ward-based measures to help make informed decisions;

Well-organised ward Making ward areas work for staff;

Patient status at a glance Providing the ward team with patient information that improves communication, patient experience and patient flow.

The programme is not designed to provide answers; rather it is a methodology to provide frontline staff with the knowledge and skills to understand how they can develop safe and reliable care systems within their ward.

It also emphasises the importance of sustainability. This will be a success if ward staff learn the skills and knowledge through implementing the modules.

The institute believes success will mean that a year down the line the modules will be gathering dust on the first wards implementing the methodology because they will have developed a new mindset, a new set of behaviours and will have the confidence to continue applying the tools and techniques based on a new way of seeing the world.

But these ward staff cannot make the journey alone. While their enthusiasm is essential, without the support and commitment of the broader organisation from the very top progress will soon founder.

Trusts should establish a steering committee, ideally chaired by the chief executive, to meet monthly and ensure there is organisational commitment to Productive Ward methodology and as a way of helping the organisation meet the programme's strategic goals.

The committee should include nursing, medical, operations and finance directors, general managers and nursing managers. This top team must commit time to ensure they are visible to ward teams adopting Productive Ward and to the wider organisation through weekly ward visits and taking part in ward improvement activity.

Trust commitment

A finance analyst and information analyst are important to create a support team and the ward team itself needs a project manager - ideally the ward manager - to drive the project. Trusts need to commit to providing cover for ward staff time spent on the project, as the early stages will increase workload.

The institute also recommends that trusts ensure there is an improvement resource - someone taken out of their day job to concentrate on Productive Ward for the suggested three months for each ward - to facilitate and support the project manager. Trusts then need to carry out a baseline data collection for all wards to understand their starting position. This should cover:

  • patient observation;

  • MRSA and Clostridium difficile infections;

  • pressure sores;

  • falls;

  • unplanned absence rate;

  • patient satisfaction;

  • ward cost per patient spell;

  • whole-time equivalent per occupied bed day;

  • direct care time;

  • length of stay;

  • bank and agency hours.

Another vital decision is to agree a showcase ward for the project and use it to promote further rollout, which should be planned at this stage. The trust start-up shows that organisations must work out their vision for implementing Productive Ward before they start. It needs to fit with a trust's organisational strategy and vision and should be seen as a delivery vehicle for many parts of the organisational strategy.

The institute says that the trust leadership team must consider how Productive Ward fits with each element of organisational strategy, how it challenges existing strategies, how to answer these challenges and what policy deployment processes are required. By defining and aligning organisational vision, goals, resulting strategies and measures throughout the organisation, trusts will be able to test if Productive Ward is really for them and ensure that if it is, then it is spread and sustained in the organisation in the most efficient manner.

While the Productive Ward is a 'bottom-up' methodology, its success depends on clear and visible links to your organisation's strategy.

Early adopters: the Productive Ward test sites

  • Barnsley Hospital foundation trust

  • Basingstoke and North Hampshire foundation trust

  • Luton and Dunstable Hospital foundation trust

  • Royal Liverpool and Broadgreen University Hospitals trust

Learning partners

  • Stockport foundation trust

  • South Tees Hospitals trust

  • Leeds Teaching Hospitals trust

  • Shrewsbury and Telford Hospital trust

  • Derby Hospitals foundation trust

  • North Middlesex University Hospital trust

  • Queen Elizabeth Hospital trust

  • Plymouth Hospitals trust

  • Portsmouth Hospitals trust

  • Ashford and St Peter's Hospital trust

'Whole hospital' sites

  • Nottingham University Hospitals trust

  • Central Manchester/Manchester Children's University Hospitals trust

The last of the Productive Ward Live events run by HSJ and sister title Nursing Times in association with the NHS institute will be held on 18 January at Barnsley Hospital foundation trust. For more information and to book go to www.hsj.co.uk/productiveward.html.

For more information on the Productive Ward programme go to www.institute.nhs.uk/productiveward