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Research project: Impact of Releasing Time to Care (the productive ward ™)

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Releasing Time to Care (TM) is a program developed by the NHS Institute for Innovation and Improvement that is now being tested in Saskatchewa, Canada. It is a patient-centred approach to improving the quality of care on acute care nursing units, by freeing up caregivers' time for more direct patient care. Although it is designed around nursing processes, everyone involved in providing care or services at the unit level - care assistants, pharmacists, therapists, physicians, housekeeping staff, maintenance workers, and dietary staff - has an important role to play in implementing Releasing Time to Care (TM).

Objective: To develop and implement rigorous evaluation methodology to study how Releasing Time to Care: The Productive Ward (RTC), a nurse-led health care improvement innovation, impacts patient and provider outcomes in hospitals in two provinces.


The Issue: Nurses currently experience insufficient time to complete their care work, which can adversely affect their job satisfaction and patient outcomes. Although the mechanisms are not completely understood, the quality and efficiency of the work environment can impact nurses' ability to spend time performing direct patient care.

The Opportunity: The Health Quality Council in Saskatchewan and The Change Foundation in Ontario, are supporting the implementation of RTC in their respective provinces. RTC was developed in England by the National Health Service to target hospital unit level improvements for both patients and providers. RTC offers a process not only to improve nurses' satisfaction and unit efficiencies, but importantly to re-focus care on the patient-a key health system priority in Canada. This innovation, first piloted in 2005, has been implemented throughout the United Kingdom as well as in New Zealand and Australia; however, to date the impacts of RTC have not been evaluated rigorously.

Design and Methods: RTC is a patient-centered, nurse-led initiative designed to increase direct nursing care time, improve patient outcomes, staff satisfaction and unit functioning. The design of RTC incorporates key concepts of empowerment, engagement, leadership, teamwork and rapid cycle improvements in structured modules that teams use to guide their improvement work. Each module focuses on different unit-level tasks and processes to achieve the initiative's core objectives. Over the study period (April 2010-March 2013), RTC will be implemented on 33 hospital units (20 hospitals) in Saskatchewan and 10 units (10 hospitals) in Ontario in successive training cycles involving 10-15 units. The evaluation will employ qualitative and quantitative methods to answer the questions: (a) Does RTC have a positive impact on hospital unit work life quality and patient outcomes? and (b) What contextual factors are important to the effectiveness of RTC? Interrupted time-series (ITS), the strongest quasi-experimental methodology will be applied in quantitative analyses. ITS regression analyses will be used to test for significant changes over time in team climate, work life quality, and patient outcomes, from up to 12 months prior to RTC implementation through to at least 12 months afterwards. Four case studies will combine qualitative and quantitative data to investigate the role of contextual factors at the person, unit, hospital and environmental levels on the impact of RTC. Quantitative data for the outcomes and covariates will be assembled from existing data sources in Saskatchewan and Ontario (administrative health and human resources data, and patient experience survey data). Primary data collection (nurse surveys, technology-assisted nurse time and activity monitoring, and key-informant interviews) will be used to gather outcome and contextual data not captured through existing data collection processes.

Significance: Evidence derived from this project will have national and international relevance for practice and policy decision-makers by providing generalizable knowledge regarding:

  • Whether and how RTC contributes to redesign of nursing workflow to make it more responsive to patients' needs and to improve work life quality for nurses;
  • The mechanisms by which the innovation incorporates quality as an integral part of providers daily work processes-including how system performance measurement and feedback can be utilized at the frontline to improve the quality of care.
  • Whether and how the innovation creates and sustains a healthy workplace environment in which nurses feel empowered and engaged in their work.

 

Project team

Peter Griffiths

Project funder

Canadian Institute of Health Services Research

Related research groups

Health Work and Systems
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