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

BMC Health Services Research

Gary Teare¹  G Ross Baker²  Kyla Avis¹  Peter Griffiths⁴  Jill Maben³  Tanya Verrall¹  Jessica Hamilton¹ 

[1] Health Quality Council, Saskatchewan, 241-111 Research Drive, Saskatoon S7N 3R2, Saskatchewan, Canada;University of Toronto, Suite 425, 155 College St, Toronto M5T 3M6, ON, Canada;King’s College London, 57 Waterloo Road, London SE1 8WA, UK;University of Southampton, Highfield, Southampton SO17 1BJ, UK

关键词: Change mechanisms;    Quality improvement capacity;    Qualitative methodology;    Nursing;    Organizing for quality;    Releasing time to care;    Productive ward;   

Others  :  1090004
DOI  :  10.1186/s12913-014-0642-x

 received in 2014-02-20, accepted in 2014-12-09,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Hamilton et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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