title: The adoption, local implementation and assimilation into routine nursing practice of a national quality improvement programme: the Productive Ward in England.
abstract: OBJECTIVE
  To explore why innovations in service and delivery are adopted and how they are then successfully implemented and eventually assimilated into routine nursing practice.
  
  
  BACKGROUND
  The 'Productive Ward' is a national quality improvement programme that aims to engage nursing staff in the implementation of change at ward level.
  
  
  METHODS
  Mixed methods (analysis of routine data, online survey, interviews) to apply an evidence-based diffusion of innovations framework.
  
  
  METHODS
  (1) Broad and narrow indicators of the timing of 'decisions to adopt' the Productive Ward were applied. (2) An online survey explored the perceptions of 150 respondents involved with local implementation. (3) Fifty-eight interviews in five organisational case studies to explore the process of assimilation in each context.
  
  
  RESULTS
  Since the launch of the programme in May 2008 staff in approximately 85% of NHS acute hospitals had either downloaded Productive Ward materials or formally purchased a support package (as of March 2009). On a narrower measure, 40% (140) of all NHS hospitals had adopted the programme (i.e. purchased a support package) with large variation between geographical regions. Four key interactions in the diffusion of innovations framework appeared central to the rapid adoption of the programme. Despite widespread perception of significant benefits, frontline nursing staff report that more needs to be carried out to ensure that impact can be demonstrated in quantifiable terms and include patient perspectives.
  
  
  CONCLUSIONS
  The programme has been rapidly adopted by NHS hospitals in England. A variety of implementation approaches are being employed, which are likely to have implications for the successful assimilation of the programme into routine nursing practice.
  
  
  CONCLUSIONS
  This paper summarises the perceived benefits of the Productive Ward programme and highlights important lessons for nurse leaders who are designing (or adapting) and then implementing quality improvement programmes locally, particularly in terms of how to frame such initiatives - and provide support to - ward-level staff.
authors.affiliation: National Nursing Research Unit, King's College London, UK. glenn.robert@kcl.ac.uk
authors.forename: Glenn
authors.initials: G
authors.lastname: Robert
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Morrow
authors.forename: Jill
authors.initials: J
authors.lastname: Maben
authors.forename: Peter
authors.initials: P
authors.lastname: Griffiths
authors.forename: Lynn
authors.initials: L
authors.lastname: Callard
mesh_terms: D004059:Diffusion of Innovation; D004739:England; D009729:Nursing; D011787:Quality of Health Care; D013222:State Medicine