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QI - Releasing Time to Care

In September 2008, the Health Quality Council (HQC) led a delegation of 19 health system leaders to England to learn more about a relatively new and promising initiative called Releasing Time to Care: The Productive Ward™ (RTC).

• Quality of Care
• Kaizen Promotion Office (KPO)

• Patient Safety
• Releasing Time to Care™
• Voice of the Customer

The delegation included members of the Ministry of Health, Saskatchewan Registered Nurses’ Association, Saskatchewan Association of Licensed Practical Nurses, Saskatchewan Union of Nurses, Five Hills Health Region, Regina Qu’Appelle Health Region, and Saskatoon Health Region.

Seven individuals received training from and were certified as Master Trainers by the National Health Service (NHS) Institute for Innovation and Improvement. The remaining delegates met with their executive-level counterparts to learn more about the successes and challenges of implementing RTC in the UK. Both groups toured various hospitals to see first-hand and hear about the impact of RTC on acute care wards.

What is Releasing Time to Care: The Productive Ward™?

RTC is a patient-centred approach to improving the quality of care on acute care nursing units. The initiative – which focuses on freeing up caregivers’ time for more direct patient care – is designed and packaged as a box set of 15 modules. Each module provides a step-by-step guide to improving processes of care using a variety of straightforward tools and techniques - some of which have been adapted from Lean methodologies. Although RTC is designed around nursing processes, everyone involved in providing care or services at the unit level – care assistants, pharmacists, therapists, physicians, housekeeping staff, maintenance workers, and dietary staff – has an important role to play in implementing RTC. (For more detailed information about the modules, go to www.institute.nhs.uk).

The Purpose

One of the aims of RTC is to increase the time health care providers spend on direct patient care. Nurses and other care providers often spend valuable time away from the patient looking for items, searching for information about patients and their plan of care, duplicating charting, and dealing with numerous interruptions. RTC helps care teams identify where they are spending time on activities that do not add value for patients. RTC also provides guidance on how to test and implement changes that improve the patient’s experience, enhance staff wellbeing, and increase
patient safety on the ward.

The Potential

In England, direct care time increased by up to 60% on one unit following implementation of RTC, allowing time to be reinvested into safer and better care for patients. A number of units that have implemented RTC have also seen a reduction in falls, pressure sores, and infections such as C.difficile and MRSA.  Staff  have also observed an increased level of patient satisfaction with the quality of care received on the unit.

Many of the care teams that have implemented RTC are more engaged and empowered by the changes they have implemented on their units. These changes have led to higher staff satisfaction and a positive shift in the culture within these units and more broadly across the organization.

The modules are simple to use but the work involved is not easy! RTC requires a commitment from all levels of an organization to truly focus on the patient. This requires a significant amount of time and challenges everyone within the organization to think differently. The good news is that once time starts to be released, more time can be invested into patient-centred improvement initiatives and soon it becomes a routine part of daily practice for everyone. Experience in England has demonstrated that when care providers are involved in redesigning processes of care, tremendous gains in patient care outcomes are possible.

Expansion of Releasing Time to Care™ program in Saskatchewan

Since 2008, 52 wards/facilities in the province have received training for and are implementing RTC.  In Spring 2011, an additional 20 wards/facilities will be added to this ever-expanding community.  Health regions across the province continue to work towards their goal of having Releasing Time to Care™ on all medical and surgical wards in the province by June 2012.

Releasing Time to Care™ has been adopted by a variety of settings - including mental health, emergency, critical care, and community hospitals. In July 2010, three Saskatchewan nursing homes were selected to test the effectiveness of Releasing Time to Care (TM) in long-term care: Moose Jaw's Providence Place, Saskatoon Convalescent Home, and St. Paul Lutheran Home in Melville.

Three years into the journey, RTC continues to engage health care providers in quality improvement and contributes to improving patient safety, patient experience, efficiency of care, and staff wellbeing across our province. You can learn more about the provincial RTC journey by visiting the Health Quality Council (HQC).

Releasing Time to Care is a trademark of the NHS Institute for Innovation and Improvement.Above information courtesy of Saskatchewan Health Quality Council.