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May 20, 2015

HQC, international collaborators publish highly accessed Releasing Time to Care research paper

A paper about Releasing Time to CareTM written by Saskatchewan Health Quality Council (HQC) researchers, in conjunction with international collaborators, was accessed online nearly 1,300 times in the three months since it was published in an open-access, peer-reviewed health journal.

The paper, which examines the Releasing Time to CareTM (RTC) method for conducting continuous quality improvement in health care, was published in the journal BMC Health Services Research in December 2014. The journal has designated the article as “highly accessed” based on the number of online accesses during the first three months since its publication.

“A number of years ago, Releasing Time to CareTM was a key provincial initiative in the health system. HQC was also involved in the implementation of the program. Implementing the program in varying contexts – in different health regions and facilities – gave us a good opportunity to evaluate the experience and the impact of the program as it was being implemented,” said Jessica Hamilton, an HQC researcher and the lead author of the paper.

“As projects are initiated in the health system, it is important to formally evaluate them to better understand the impact they have. This work also afforded us the opportunity to work with international experts involved in RTC and strengthen relationships with them.”

The paper resulted from research that was funded by the Canadian Institutes of Health Research (CIHR) and the Saskatchewan Health Research Foundation (SHRF). Partnership funding for the research was also provided by HQC and by the Saskatchewan Union of Nurses – Saskatchewan Government partnership. Other authors on the paper included national and international co-investigators: Tanya Verrall, Gary Teare, and Kyla Avis from HQC; Ross Baker, from the University of Toronto; Jill Maben, from King’s College London; and Peter Griffiths, from the University of Southampton.

The National Health Service Institute for Innovation and Improvement in the United Kingdom developed RTC, and it was first implemented there in 2007. In 2008, Saskatchewan began a pilot test of the initiative, and a government-mandated province-wide implementation occurred from 2010-2012. After interviewing staff from eight nursing units, the researchers concluded that RTC has the potential to be a strong tool for engaging units to undertake quality improvement work, but that occurs best when RTC is implemented in a supportive environment.

“Our research found that the RTC program has a positive impact on the nursing unit environment and on patient care. However, the extent of the impact depends on several elements of hospital nursing unit context, and not every unit has the foundation in place to support success with this improvement work. Sometimes there are other key issues that should be addressed before starting a program like this,” said Hamilton.

Hamilton said Saskatchewan’s health system, as well as health systems in other parts of the world, can learn from the research team’s findings. Specifically, the team found that “one size does not fit all” when implementing a quality improvement program.

“Sometimes the same program will work great in one environment and not at all in another. We can’t expect the same results from different environments and the health system should tailor support in each unique environment to help it achieve success,” she said.

The RTC program, which was implemented in medical and surgical hospital units, is no longer being used in Saskatchewan. The foundations of the RTC program were based on Lean methodology, which is now being utilized to transform Saskatchewan’s entire health system.

“RTC laid the groundwork for using Lean in our health care system,” said Teare, HQC’s CEO.

The mission of HQC is to accelerate improvement in the quality of health care in Saskatchewan. Hamilton said it is important for HQC to publish research articles and to share its work with others.

“RTC is implemented across the world, and hopefully our experience and the lessons learned here will be useful to others who are trying to implement it in their system,” she said.  

The high rate of online accesses of the published article suggests there is wide international interest in RTC and in understanding how to successfully use the program to improve care. Since Saskatchewan’s use of RTC, it has also been used in other Canadian provinces and in Australia and New Zealand. It continues to be used in the U.K.

To read the research paper – entitled “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” – visit http://www.biomedcentral.com/1472-6963/14/642.

Photo: Jessica Hamilton