title: The impact of a large-scale quality improvement programme on work engagement: preliminary results from a national cross-sectional-survey of the 'Productive Ward'.
abstract: BACKGROUND
  Quality improvement (QI) Programmes, like the Productive Ward: Releasing-time-to-care initiative, aim to 'engage' and 'empower' ward teams to actively participate, innovate and lead quality improvement at the front line. However, little is known about the relationship and impact that QI work has on the 'engagement' of the clinical teams who participate and vice-versa.
  
  
  OBJECTIVE
  This paper explores and examines the impact of a large-scale QI programme, the Productive Ward, on the 'work engagement' of the nurses and ward teams involved.
  
  
  METHODS
  Using the Utrecht Work Engagement Scale (UWES), we surveyed, measured and analysed work engagement in a representative test group of hospital-based ward teams who had recently commenced the latest phase of the national 'Productive Ward' initiative in Ireland and compared them to a control group of similar size and matched (as far as is possible) on variables such as ward size, employment grade and clinical specialty area.
  
  
  RESULTS
  338 individual datasets were recorded, n=180 (53.6%) from the Productive Ward group, and n=158 (46.4%) from the control group; the overall response rate was 67%, and did not differ significantly between the Productive Ward and control groups. The work engagement mean score (±standard deviation) in the Productive group was 4.33(±0.88), and 4.07(±1.06) in the control group, representing a modest but statistically significant between-group difference (p=0.013, independent samples t-test). Similarly modest differences were observed in all three dimensions of the work engagement construct. Employment grade and the clinical specialty area were also significantly related to the work engagement score (p<0.001, general linear model) and (for the most part), to its components, with both clerical and nurse manager grades, and the elderly specialist areas, exhibiting substantially higher scores.
  
  
  CONCLUSIONS
  The findings demonstrate how QI activities, like those integral to the Productive Ward programme, appear to positively impact on the work engagement (the vigour, absorption and dedication) of ward-based teams. The use and suitability of the UWES as an appropriate measure of 'engagement' in QI interventions was confirmed. The engagement of nurses and front-line clinical teams is a major component of creating, developing and sustaining a culture of improvement.
authors.affiliation: Nursing & Midwifery Planning & Development Unit, HSE-South, Kilcreene Hospital, Kilkenny, Ireland. Electronic address: whiteser@eircom.net.
authors.forename: Mark
authors.initials: M
authors.lastname: White
authors.affiliation: School of Health Science, Waterford Institute of Technology, Waterford, Ireland.
authors.forename: John S G
authors.initials: JS
authors.lastname: Wells
authors.affiliation: Healthcare Workforce Innovation, University of Lincoln, UK.
authors.forename: Tony
authors.initials: T
authors.lastname: Butterworth
mesh_terms: D003430:Cross-Sectional Studies; D009741:Nursing Staff, Hospital; D058996:Quality Improvement; D006113:United Kingdom
keywords: Employee engagement; Health service research; Hospital units; Lean healthcare; Multidisciplinary care team; Nurse attitudes; Productive Ward; Program implementation; Quality improvement