The Productive Ward is in full swing at St Vincent’s Hospital. The core aim of the program is to “release time to care” – that is, to maximise workplace efficiency in order to spend more time in direct contact with patients.
The foundation of this improvement framework is to understand, via objective data, exactly how much time is spent with patients versus the activities that take clinical staff away from the bedside. The next step is to systematically tackle some of the things that “get in the way” of direct patient care time.
The Productive Ward program is in implementation in hospitals all over the world. At the start of the Productive journey, Australasian data indicates that for most inpatient ward types and settings, nurses typically spend 25-35% of their shifts in direct contact with patients. This figure is surprising to most staff members who complete the training and yet, similar percentages are found on the majority of Australian wards, including some at St Vincent’s, at baseline.
In order to determine this direct care time figure, staff on the 24 Productive inpatient areas at St Vincent’s complete “activity follows” at regular intervals. This time-in-motion study involves one staff member following another for the entirety of a shift, all the while noting the precise activity being completed at 60 second intervals. There is also room to note the exact location of the staff member and any interruptions throughout the shift. This information is then entered into a spreadsheet and a graph is produced which splits shift into activity categories: time spent with patients, in motion, completing documentation, in meetings, completing hand hygiene etc.
The activity follow is a tiring but vital process. The follower, “ninja” or “shadow,” is the person who is able to objectively observe processes and evaluate if there is any opportunity to innovate. He or she is able to ask the team, “Why have we always kept this stock in that location?” or, “How do we ensure that every observation machine is charged and easy to find?”
Activity follow results are displayed publicly on the ward and discussed as a team at the ward’s weekly problem-solving huddle.
Here, Michelle is following Jess, a nurse on 10 East. Once a minute, she marks down Jess’ activity and location – in this case, completing documentation at the nurses’ station. Michelle also notes any interruptions and insights into processes on the ward. She comments that as Jess is looking after patients located in a number of different rooms, she spends more time in motion than other nurses on the same shift.
10 East staff will soon be able to analyse Michelle’s activity follow data and diagnose opportunities to become even more efficient as a team.