The drive to develop tools to help acute staff improve their ward processes and help nursing staff spend more time on patient care has moved forward with the creation of 10 'learning partner' trusts and two 'whole hospital' sites to road test the draft modules.

The NHS Institute for Innovation and Improvement has added the acute trusts to its Productive Ward programme to build on continuing work at hospital test sites in Barnsley, Basingstoke, Luton and Liverpool.

The Productive Ward programme focuses on improving ward processes and environments to increase efficiency and help nurses and therapists spend more time on patient care. Some of the core processes include meal rounds, drug rounds, handover, observation and discharge planning. The programme also aims to achieve associated improvements in patient safety and staff satisfaction and reduced lengths of stay.

NHS Institute senior associate on the Productive Ward programme Sean Manning says: 'In the test phase, we had some very successful experiences but also some significant challenges.

'We tried to pull together all the learning successes and challenges together into a range of draft modules which fundamentally cover start-up, foundation modules and process modules, the blocks for what it takes to implement these improvements.'

Building blocks

The NHS Institute says that for organisations to begin the Productive Ward journey, they need some essential elements in place:

  • top-level organisational support;

  • time for staff to understand and improve their ward;

  • information on what is working well;

  • improvement tools and techniques;

  • staff understanding of what is going to happen and their role in it;

  • a stable ward with good leadership.

Once these elements are in place, staff on wards can begin evaluating the physical environment and key processes and begin making improvements.

This latest prototype phase will focus on three areas: feedback on draft modules; the impact of Productive Ward on length of stay and infection rates; and feedback on the general experience of implementation.

Rolling out

The learning partners will provide valuable evidence of their experience in implementing Productive Ward in a single ward without the expert support afforded to the test sites. The two whole hospital sites are going further, committing to using Productive Ward as a strategic tool to improve patient care and achieve organisational requirements.

'We want to know their experiences of implementing modules in multiple wards at the same time and then rolling out to further wards,' says Mr Manning. For example, in Central Manchester and Manchester Children's University Hospitals trust there will be four wards in a first wave of implementation, four more in a second wave a couple of months on and so on.

'We are going to be with all these trusts for six months on these different journeys, learning what they think of the draft modules and their impact on areas such as infection rates and staff costs,' adds Mr Manning.

'We'll also see how the learning partners progress with limited support and how the whole hospital sites attempt to get Productive Ward permeating through their organisations.'

In the first quarter of next year, the NHS Institute will start to release the finalised modules for NHS trusts to take forward Productive Ward in their own organisations.

'Plus we will also have developed further our understanding of the help, support and guidance needed in addition to the modules,' adds Mr Manning. 'We have plans in place to provide that as well.'

The trusts involved in the prototype phase are also providing feedback on measures the NHS Institute has developed for hospitals to use at ward, division and trust-wide levels to gauge progress and improvements during the Productive Ward programme. The measures cover:

  • patient observation;

  • MRSA and Clostridium difficile infection rates;

  • pressure sores;

  • numbers of falls;

  • unplanned absence rates;

  • patient satisfaction;

  • cost per patient spell;

  • numbers of whole-time equivalent staff per occupied bed day;

  • proportion of direct care time;

  • length of stay per spell;

  • bank and agency hours.

'It's fair to say we are being challenged and have been discussing with the trusts the appropriateness of the measures and the practical challenges of getting meaningful data,' says Mr Manning.

'We are not trying to make these things academic in nature and wieldy. They need to be comprehensive but useful.'

Productive Ward background

The Productive Ward programme was launched in April this year by chief nursing officer Christine Beasley. A survey of more than 2,100 acute trust nurses, managers and therapists by HSJ and sister title Nursing Times to coincide with the launch showed that 73 per cent of nurses and 76 per cent of therapists felt they did not spend enough time on direct patient care. More than four in five of those staff said this had an adverse impact on the care of patients.

'It's important to recognise the amazing interest that's been generated,' says Mr Manning. 'This has struck a chord; we were inundated with applications to be learning partners.'

Mr Manning says some strategic health authorities were planning to set up Productive Ward networks and build up supportive learning sets in their regions to harness the enthusiasm of staff to improve their wards and release more time to spend on patient care.

'Ward staff know they are working their socks off but they know as well the care they give could be better,' says Mr Manning.

Find out more about the Productive Ward programme at and from the NHS Institute

The 10 Productive Ward learning partners

  • Stockport foundation trust

  • South Tees Hospitals trust

  • Leeds Teaching Hospitals trust

  • Shrewsbury and Telford Hospital trust

  • Derby Hospitals trust

  • North Middlesex University Hospital trust

  • Queen Elizabeth Hospital trust

  • Plymouth Hospitals trust

  • Portsmouth Hospitals trust

  • Ashford and St Peter's Hospitals trust

The two 'whole hospital' sites

  • Nottingham University Hospitals trust

  • Central Manchester and Manchester Children's University Hospitals trust

Productive Ward draft modules

  • Agreement

  • Trust start-up

  • Ward start-up

  • Knowing how we are doing

  • Toolkit

  • Well-organised ward

  • Patient status at a glance

  • Patient observations

  • Admissions and discharge management

  • Shift handovers

  • Meals

  • Medicines

Productive Ward Live events

HSJ and sister title Nursing Times have teamed up with the NHS Institute for Innovation and Improvement to hold events at each of the four Productive Ward test sites for managers, nurses and therapists to learn from the experiences of these organisations in ward-level change. Delegates will also get the latest feedback on progress at learning partners and whole sites from the NHS Institute.

The dates are:

  • 19 November, Royal Liverpool and Broadgreen University Hospitals trust

  • 28 November, Luton and Dunstable Hospital foundation trust

  • 5 December, Basingstoke and North Hampshire foundation trust

  • 18 January, Barnsley Hospital foundation trust