Productive practice in health care

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This practice question has been published with the kind permission of the Royal College of Nursing

Productive working is often associated with manufacturing, where being productive results in producing items. Many of the techniques that can be used to assess and improve productivity originated in the car manufacturing industry.

In recent years the techniques used in such industries have been adapted to support the delivery of health services. A range of productive modules and associated tools have been developed by the NHS Institute for Innovation and Improvement (2006-2011).

So why should productive working be embraced by front line care staff, many of whom would argue that they are already busy, with not enough time to do anything else? Remember that being busy does not always mean that you are being productive, effective or efficient.

Using a systematic approach to adopt these techniques has been shown to support the delivery of cost-effective patient care as well as improving safety by developing consistency in care. Their use also leaves more time available for face-to-face contact with patients.

This Practice Question has been published with the kind permission of the Royal College of Nursing

It is essential in these times of financial constraint that front line staff can prove what they do has benefits for patients, is safe and is provided in the most economical way. The skills and time of staff are the main resources in healthcare organisations, so ensuring that staff do not waste time and that the time and skills they possess are used in the most effective way is vital. That means maximising the time available to spend with patients, providing care that is effective each time.

Take a moment to think about what you have done today. Can you honestly say that everything you have needed to do your job has been at your fingertips the moment you needed it? Have you wasted ten minutes looking for something which was missing or put away in the wrong place? Calculate how much time is lost and the associated costs if this is replicated for each member of staff on each shift. For example: six members of staff x ten minutes wasted = 60 minutes x three shifts in 24 hours = three hours a day of wasted time.

The Well Organised Working Environment (WOWE) is one of the first modules in all the productive programmes. To some it has become known as ‘tidying cupboards’, and was initially seen as either trite or insulting, until individuals began to see how much time can be redirected to patient care when ineffective activity is reduced.

Take a moment to test how organised one of your store cupboards is.

Give a list of five items to a colleague, all of which should be found easily because they are used frequently. Time how long he or she takes to locate them. Get feedback about how easy it was or what made the task harder. Then, using the 5Ss: sort, set, shine, standardise and sustain, tidy up the environment, de-clutter and ask yourself and the team if frequently used items are stored near to where they are used. Label where the items are stored and get everyone involved in discussing where is the best place to keep items.

Do you run out of items resulting in omissions of appropriate care because there is no process for minimal stock level monitoring and automatic reordering when it reaches that level? Using productive modules ensures that all staff can play a part in designing their working environment, supporting them to critically examine the way they work as individuals and as a team. It encourages front line workers to devise innovative ways to deliver care, reduce waste and increase time spent with patients, resulting in safer quality care.