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One size does not fit all: a qualitative content analysis of the importance of existing quality improvement capacity in the implementation of Releasing Time to Care: the Productive Ward™ in Saskatchewan, Canada.

Hamilton J, Verrall T, Maben J, Griffiths P, Avis K, Baker GR, Teare G - BMC Health Serv Res (2014)

Bottom Line: Staff on unit E did not have the same experience with RTC.One size does not fit all and administrative bodies must consider the unique context of each environment prior to implementing large-scale QI projects.Use of an established framework, like Organizing for Quality, could highlight the distinctive supports needed in particular care environments to increase the likelihood of successful engagement.

View Article: PubMed Central - PubMed

Affiliation: Health Quality Council, Saskatchewan, 241-111 Research Drive, Saskatoon S7N 3R2, Saskatchewan, Canada. jhamilton@hqc.sk.ca.

ABSTRACT

Background: Releasing Time to Care: The Productive Ward™ (RTC) is a method for conducting continuous quality improvement (QI). The Saskatchewan Ministry of Health mandated its implementation in Saskatchewan, Canada between 2008 and 2012. Subsequently, a research team was developed to evaluate its impact on the nursing unit environment. We sought to explore the influence of the unit's existing QI capacity on their ability to engage with RTC as a program for continuous QI.

Methods: We conducted interviews with staff from 8 nursing units and asked them to speak about their experience doing RTC. Using qualitative content analysis, and guided by the Organizing for Quality framework, we describe the existing QI capacity and impact of RTC on the unit environment.

Results: The results focus on 2 units chosen to highlight extreme variation in existing QI capacity. Unit B was characterized by a strong existing environment. RTC was implemented in an environment with a motivated manager and collaborative culture. Aided by the structural support provided by the organization, the QI capacity on this unit was strengthened through RTC. Staff recognized the potential of using the RTC processes to support QI work. Staff on unit E did not have the same experience with RTC. Like unit B, they had similar structural supports provided by their organization but they did not have the same existing cultural or political environment to facilitate the implementation of RTC. They did not have internal motivation and felt they were only doing RTC because they had to. Though they had some success with RTC activities, the staff did not have the same understanding of the methods that RTC could provide for continuous QI work.

Conclusions: RTC has the potential to be a strong tool for engaging units to do QI. This occurs best when RTC is implemented in a supporting environment. One size does not fit all and administrative bodies must consider the unique context of each environment prior to implementing large-scale QI projects. Use of an established framework, like Organizing for Quality, could highlight the distinctive supports needed in particular care environments to increase the likelihood of successful engagement.

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Overview of RTC rollout in Saskatchewan. Figure 1 provides an overview of the roll-out strategy for RTC implementation in Saskatchewan. 12 demonstration units implemented RTC starting in September 2008 and September 2009. Following this, the government mandated that all medical and surgical units in Saskatchewan hospitals implement RTC. 14 units began implementing RTC in wave 1 starting in September 2010. 11 units started implementing RTC in wave 2 in January 2011 and 9 units began in wave 3 in September 2011. These 34 units were part of the provincial RTC evaluation that was conducted alongside the government-mandated initiative. 8 of the 34 units were selected to be part of the qualitative study. Information on all 8 units is included in this manuscript but the focus is on 2 units – unit B, which started in wave 1 in September 2010 and unit E, which started in wave 2 in January 2011.
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Fig1: Overview of RTC rollout in Saskatchewan. Figure 1 provides an overview of the roll-out strategy for RTC implementation in Saskatchewan. 12 demonstration units implemented RTC starting in September 2008 and September 2009. Following this, the government mandated that all medical and surgical units in Saskatchewan hospitals implement RTC. 14 units began implementing RTC in wave 1 starting in September 2010. 11 units started implementing RTC in wave 2 in January 2011 and 9 units began in wave 3 in September 2011. These 34 units were part of the provincial RTC evaluation that was conducted alongside the government-mandated initiative. 8 of the 34 units were selected to be part of the qualitative study. Information on all 8 units is included in this manuscript but the focus is on 2 units – unit B, which started in wave 1 in September 2010 and unit E, which started in wave 2 in January 2011.

Mentions: Similar to the initial roll-out in the UK, RTC implementation in Saskatchewan was originally planned as a ‘pull’ spread strategy. Between fall 2008 and fall 2009, twelve units volunteered to participate as initial demonstration unitsa. However, a ‘push’ spread strategy was adopted in April 2010, when the Ministry of Health directed the health system to implement RTC in all medical and surgical units within tertiary and secondary hospitals by March 31, 2012 [5]. Each health organization identified the medical and surgical units assigned to each implementation wave. See Figure 1 for an overview of the provincial roll-out. For purposes of the roll-out, the Ministry of Health considered units to have ‘implemented’ RTC when they had completed the three foundational modules plus one process module. Financial and QI coaching support was provided to help the units. The program was rolled out in three waves starting in September 2010. In spring 2012, support for RTC formally ended as the provincial government shifted the health system’s focus to implementation of a broader system-wide Lean-focused transformation effort led by an external consulting group [25]. At that time, sixty percent of the medical and surgical units in the province (20 out of 34) had ‘implemented’ RTC based on the definition in the provincial directive. As of fall 2014, elements of RTC still exist on some units, but most have stopped formally using the program and are focusing on the system-wide Lean transformation.Figure 1


One size does not fit all: a qualitative content analysis of the importance of existing quality improvement capacity in the implementation of Releasing Time to Care: the Productive Ward™ in Saskatchewan, Canada.

Hamilton J, Verrall T, Maben J, Griffiths P, Avis K, Baker GR, Teare G - BMC Health Serv Res (2014)

Overview of RTC rollout in Saskatchewan. Figure 1 provides an overview of the roll-out strategy for RTC implementation in Saskatchewan. 12 demonstration units implemented RTC starting in September 2008 and September 2009. Following this, the government mandated that all medical and surgical units in Saskatchewan hospitals implement RTC. 14 units began implementing RTC in wave 1 starting in September 2010. 11 units started implementing RTC in wave 2 in January 2011 and 9 units began in wave 3 in September 2011. These 34 units were part of the provincial RTC evaluation that was conducted alongside the government-mandated initiative. 8 of the 34 units were selected to be part of the qualitative study. Information on all 8 units is included in this manuscript but the focus is on 2 units – unit B, which started in wave 1 in September 2010 and unit E, which started in wave 2 in January 2011.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4279911&req=5

Fig1: Overview of RTC rollout in Saskatchewan. Figure 1 provides an overview of the roll-out strategy for RTC implementation in Saskatchewan. 12 demonstration units implemented RTC starting in September 2008 and September 2009. Following this, the government mandated that all medical and surgical units in Saskatchewan hospitals implement RTC. 14 units began implementing RTC in wave 1 starting in September 2010. 11 units started implementing RTC in wave 2 in January 2011 and 9 units began in wave 3 in September 2011. These 34 units were part of the provincial RTC evaluation that was conducted alongside the government-mandated initiative. 8 of the 34 units were selected to be part of the qualitative study. Information on all 8 units is included in this manuscript but the focus is on 2 units – unit B, which started in wave 1 in September 2010 and unit E, which started in wave 2 in January 2011.
Mentions: Similar to the initial roll-out in the UK, RTC implementation in Saskatchewan was originally planned as a ‘pull’ spread strategy. Between fall 2008 and fall 2009, twelve units volunteered to participate as initial demonstration unitsa. However, a ‘push’ spread strategy was adopted in April 2010, when the Ministry of Health directed the health system to implement RTC in all medical and surgical units within tertiary and secondary hospitals by March 31, 2012 [5]. Each health organization identified the medical and surgical units assigned to each implementation wave. See Figure 1 for an overview of the provincial roll-out. For purposes of the roll-out, the Ministry of Health considered units to have ‘implemented’ RTC when they had completed the three foundational modules plus one process module. Financial and QI coaching support was provided to help the units. The program was rolled out in three waves starting in September 2010. In spring 2012, support for RTC formally ended as the provincial government shifted the health system’s focus to implementation of a broader system-wide Lean-focused transformation effort led by an external consulting group [25]. At that time, sixty percent of the medical and surgical units in the province (20 out of 34) had ‘implemented’ RTC based on the definition in the provincial directive. As of fall 2014, elements of RTC still exist on some units, but most have stopped formally using the program and are focusing on the system-wide Lean transformation.Figure 1

Bottom Line: Staff on unit E did not have the same experience with RTC.One size does not fit all and administrative bodies must consider the unique context of each environment prior to implementing large-scale QI projects.Use of an established framework, like Organizing for Quality, could highlight the distinctive supports needed in particular care environments to increase the likelihood of successful engagement.

View Article: PubMed Central - PubMed

Affiliation: Health Quality Council, Saskatchewan, 241-111 Research Drive, Saskatoon S7N 3R2, Saskatchewan, Canada. jhamilton@hqc.sk.ca.

ABSTRACT

Background: Releasing Time to Care: The Productive Ward™ (RTC) is a method for conducting continuous quality improvement (QI). The Saskatchewan Ministry of Health mandated its implementation in Saskatchewan, Canada between 2008 and 2012. Subsequently, a research team was developed to evaluate its impact on the nursing unit environment. We sought to explore the influence of the unit's existing QI capacity on their ability to engage with RTC as a program for continuous QI.

Methods: We conducted interviews with staff from 8 nursing units and asked them to speak about their experience doing RTC. Using qualitative content analysis, and guided by the Organizing for Quality framework, we describe the existing QI capacity and impact of RTC on the unit environment.

Results: The results focus on 2 units chosen to highlight extreme variation in existing QI capacity. Unit B was characterized by a strong existing environment. RTC was implemented in an environment with a motivated manager and collaborative culture. Aided by the structural support provided by the organization, the QI capacity on this unit was strengthened through RTC. Staff recognized the potential of using the RTC processes to support QI work. Staff on unit E did not have the same experience with RTC. Like unit B, they had similar structural supports provided by their organization but they did not have the same existing cultural or political environment to facilitate the implementation of RTC. They did not have internal motivation and felt they were only doing RTC because they had to. Though they had some success with RTC activities, the staff did not have the same understanding of the methods that RTC could provide for continuous QI work.

Conclusions: RTC has the potential to be a strong tool for engaging units to do QI. This occurs best when RTC is implemented in a supporting environment. One size does not fit all and administrative bodies must consider the unique context of each environment prior to implementing large-scale QI projects. Use of an established framework, like Organizing for Quality, could highlight the distinctive supports needed in particular care environments to increase the likelihood of successful engagement.

Show MeSH