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Releasing Time To Care At North Shore Hospital

MEDIA RELEASE 11 November 2008

Releasing Time To Care At North Shore Hospital

An internationally acclaimed programme that frees nurses up to spend more time on direct patient care is being implemented at North Shore Hospital.

The Productive Ward - Releasing Time to Care programme was developed by the UK’s National Health Service (NHS) Institute for Innovation and Improvement in Coventry, England.

Waitemata District Health Board is the first DHB in the country to implement the initiative.

“The programme helps nurses to streamline the set-up and activities on their ward so that tasks take less time and nurses can spend the time saved on direct patient care,” says Marion Dixon, North Shore Hospital’s unit manager for Medicine.

Marion says this leads to greater reliability, safety and efficiency of patient care, and an improved, less stressful working environment for staff.

The programme is initially being rolled out in Ward 11 at North Shore Hospital, but other wards are set to follow suit.

Results of the programme in the UK have been dramatic, including an increase in the amount of time nurses can spend on direct patient care from 20 per cent to 60 per cent.

Other results have included a 63 per cent decrease in the time spent on medicine rounds and interruptions reducing by over half per nurse shift.

Ward 11 charge nurse manager Debbie Hogan says that over the coming months, practical modules will help her nurses apply simple, effective techniques proven to save time and money.

“One example could be reducing the time nurses spend physically delivering meals so they can directly help patients at mealtimes and perform proactive nutritional assessments instead.”

“The programme is run by the nurses, for the nurses and the staff on my ward are very positive about it. We can work smarter rather than harder and it enables us to provide greater quality care with less stress and without any additional resources,” Debbie says.

Marion Dixon says the concepts aren’t necessarily ‘rocket science’ and that some have been tried before.

“But they often lacked sustainability. Now we have a well-developed package to help us make permanent change and overcome some of the old barriers such as lack of time, resources and staff.”

Both Debbie Hogan and Marion Dixon attended the first ever international summer school held by the NHS Institute for Innovation and Improvement at the University of Warwick in September.

They learnt about the Productive Ward programme, saw it in action, and are now Certified Master Trainers. They launched the programme to Ward 11 staff at North Shore Hospital on October 28 and 30.

The pair say it will take six to 12 months to fully embed changes and see improvements, but that taking time and doing the groundwork thoroughly is what makes the Productive Ward programme so successful.

Waitemata District Health Board is also currently implementing a similar programme – Optimising the Patient Journey – in its Emergency Care Centres at North Shore and Waitakere Hospitals.

For more information about the programme, visit


What is the Releasing Time to Care – Productive Ward programme?

o It is a programme that frees nurses up to spend more time on direct patient care in an improved nursing environment.
o Practical modules are applied to improve and streamline hospital ward processes, thereby releasing nurses’ time to care.
o The flow-on effect is enhanced reliability, safety and efficiency of patient care – and an improved working environment for staff.
o In essence, it is a way of working smarter rather than harder.
Who designed the Releasing Time to Care – Productive Ward programme?

o The modules have been developed by the National Health Service (NHS) Institute for Innovation and Improvement at the University of Warwick in Coventry, England.
o Visit for more information.
How does the Releasing Time to Care – Productive Ward programme work?
o It works by implementing techniques that are simple, yet effective, and which offer dramatic time and money-saving results in healthcare settings.
o Wards firstly implement three foundation modules that gather information about what currently happens on the ward, reorganise where things are kept, and redesign the patient whiteboard. These are called:
- Knowing how we are doing
- Well organised ward
- Patient status at a glance

o Wards then implement modules that help streamline key ward processes such as:
- Meals
- Medicines
- Shift Handovers
- Patient Observation

An example of such streamlining might be reducing the time spent physically delivering meals so more time can be spent helping patients with their meals and performing proactive nutritional assessments.

Where is the programme being implemented at Waitemata DHB?
o The programme is being rolled out first in Ward 11 at North Shore Hospital but will subsequently be implemented by other Waitemata DHB hospital wards.
When did the programme begin at North Shore Hospital?

o Debbie Hogan, North Shore Hospital Ward 11 charge nurse manager, and Marion Dixon, unit manager for Medicine, attended the programme’s first-ever international summer school in the UK in late September 2008.
o As a result, they are now Certified Master Trainers and launched the programme to Ward 11 staff back in New Zealand on October 28 and 30.

o The summer school was held at NHS Institute for Innovation and Improvement at the University of Warwick in Coventry, and was attended by eight other New Zealand delegates including three from the Ministry of Health.
o Currently Ward 11 is implementing the three foundation modules to gather data. Part of this involves ‘Activity Follows’ - videoing nurses on the ward to help analyse how much time is spent in direct patient care, and what processes could be streamlined.
Why did Waitemata DHB choose to implement the programme?

o Because it has proven itself an effective way to improve not only patient care and safety, but also staff satisfaction by giving them greater control over their work environment and reducing stress. Wastage is also reduced.

o Once the changes are fully embedded, it is hoped that similar improvements to those documented in the UK may be experienced:

- Direct care time with patients increased by up to 60 per cent (the equivalent of adding more nurses to a ward)
- Medicine round time decreased by up to 63 per cent
- Meal round time reduced by up to 50 per cent and nutritional outcomes improved
- Handover time reduced by up to 33 per cent and quality increased
- Meal wastage reduced – one UK ward saved over £10,000 annually in reduced meal wastage
- Interruptions reduced by over half per nurse shift
o It is hoped the programme will also enable staff to use their time to best effect, and that being on the ward will be a more satisfying experience for both staff and patients.
o Due to its success, the programme is currently being implemented by every acute Trust within the NHS in the UK.

How long does the programme take to implement?
o Because the aim of the programme is to create permanent change, a lot of time is spent gathering base data, analysing what currently happens in the ward and identifying where changes can be made.
o It is expected to take around six to 12 months before changes are fully embedded and improvements are seen.
How will the Releasing Time to Care – Productive Ward programme be evaluated?
o Audits are carried out regularly until the desired change is embedded. ‘Regular’ could mean every day.
o The programme also involves posting data about efficiency and reliability of care, patient safety, staff wellbeing, and the patient experience in a prominent place on the ward. This enables both staff and patients to see the current situation on the ward, current action areas for improvement, and achievements.
If the techniques used in the Releasing Time to Care – Productive Ward programme are so simple, why haven’t they been implemented before?
o Some of the changes have been attempted before but have lacked the sustainability component that ensures the change is permanent.
o The Productive Ward programme is well-developed and organised, and is structured in such a way that the usual barriers to change can be overcome. These include interruptions and lack of time, training, resources and staff.
Who else is implementing this programme?

o Waitemata DHB is the first DHB in New Zealand to implement Releasing Time to Care – Productive Ward programme.

o However, representatives from the Ministry of Health and Waikato, Bay of Plenty, Hutt Valley, Wairarapa, West Coast and South Canterbury DHBs have also undergone programme training at the Institute for Innovation and Improvement in the UK.

o A similar ‘lean methodology’ approach has also been adopted by Counties Manukau DHB.

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