An Evaluative Implementation Study of the Productive Ward in Ireland

This study uses an ‘action evaluation’ approach to examine the effects of a national Quality Improvement (QI) initiative, the Productive Ward: Releasing Time to Care™ Programme (PW) on a pilot cohort of ward-based teams in the Irish Health Service Executive (HSE). In particular it measures their ‘engagement’ and explores their experiences and views in relation to implementation and efficacy. It is one of the first studies to examine the impact of QI activities and interventions on ‘work engagement’ (WE). With the researcher–evaluator integrated within the implementation, this study uses an explanatory, sequential, mixed method design (with an experimental test outcome) to gather data through four empirical phases for the purpose of in-depth analysis. The first phase, a survey, measured work engagement in the PW group and compared the results to a matched control group. The second phase involved a qualitative interview study with participants from the PW group. The third phase was a longitudinal 12-month repeat WE survey. The final phase utilised the improvement performance measure, Direct Patient Care (DPC) times, from the PW group for comparison with corresponding WE scores. Overall findings established higher WE scores amongst the PW group that were maintained over the 12-month period. In-depth interview analysis identified key determinants from the participants’ accounts which impacted implementation, including project management structures, prior preparation, training and negative experiences. Further qualitative analysis also highlighted key outcomes/outputs that the programme had delivered, including many positive experiences which naturally align with the construct of WE. This study validates previous assertions that QI activities, like PW, can actively ‘engage’ participating employees. It also identifies a number of key implementation determinants that can help or hinder efficacy and provides guidance for practitioners who are considering introducing the initiative.