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This paper reviews the Lean Healthcare and Productive Ward: releasing time to care (RTC) literature and extracts the reported effects and impacts experienced by employees who implement it. The purpose of this paper is to identify and investigate the strength of the connection between the two models and explores the implications for leadership and implementation.

This study reviewed the Lean Healthcare and Productive Ward: RTC literature using strict systematic inclusion criteria. A qualitative content analysis was used to identify key characteristics of reported employee experience, effect or impact. Themes and categories were ranked by the number of citations and presented.

This study outlines the similar employee effects and impacts that exist between Lean-type improvement initiatives and the Productive Ward: RTC programme. It discusses the three top themes of: Empowerment, Leadership and Engagement and explores the opportunities for leadership. It also identifies one key difference between the two initiatives, the socio-cultural effect and impact which is strongly reported with Lean-type improvement initiatives. The socio-cultural element is discussed and presented as one of the fundamental aspects of Lean and the original Toyota production system.

This study brings new insights for leaders involved in Lean-type improvement initiatives which are currently being imported into healthcare and provides a comprehensive list of reported employee impacts and effects of value to healthcare leaders attempting to establish an environment and culture of improvement.

The purpose of this paper is to present findings relating to how Lean is implemented in English hospitals.

Lean implementation snapshots in English hospitals were conducted by content analysing all annual reports and web sites over two time periods, giving a thorough analysis of Lean's status in English healthcare.

The article identifies divergent approaches to Lean implementation in English hospitals. These approaches are classified into a typology to facilitate an evaluation of how Lean is implemented. The findings suggest that implementation tends to be isolated rather than system‐wide. A second dataset conveys Lean implementation trajectory across the time period. These data signal Lean's increasing use by English hospitals and shows progression towards an increasingly systemic approach.

Data were collected using content analysis methods, which relies on how “Lean” methods were articulated within the annual report and/or on the organisation's web site, which indicates approaches taken by hospital staff implementing Lean.

This research is the first to examine more closely “how” Lean is implemented in English hospitals. The emergent typology could prove relevant to other public sector organizations and service organisations more generally. The research also presents a first step to understanding Lean thinking in the English NHS. This article empirically analyses Lean implementation in English hospitals. It identifies divergent approaches that allow inferences about how far Lean is implemented in an organisation. Data represent a baseline for further analysis so that Lean implementation can be tracked.

This paper aims to focus on facilitating large‐scale quality improvement in health care, and specifically understanding more about the known challenges associated with implementation of lean innovations: receptivity, the complexity of adoption processes, evidence of the innovation, and embedding change. Lessons are drawn from the implementation of The Productive Ward: Releasing Time to Care™ programme in English hospitals.

The study upon which the paper draws was a mixed‐method evaluation that aimed to capture the perceptions of three main stakeholder groups: national‐level policymakers (15 semi‐structured interviews); senior hospital managers (a national web‐based survey of 150 staff); and healthcare practitioners (case studies within five hospitals involving 58 members of staff). The views of these stakeholder groups were analysed using a diffusion of innovations theoretical framework to examine aspects of the innovation, the organisation, the wider context and linkages.

Although The Productive Ward was widely supported, stakeholders at different levels identified varying facilitators and challenges to implementation. Key issues for all stakeholders were staff time to work on the programme and showing evidence of the impact on staff, patients and ward environments.

To support implementation, policymakers should focus on expressing what can be gained locally using success stories and guidance from “early adopters”. Service managers, clinical educators and professional bodies can help to spread good practice and encourage professional leadership and support. Further research could help to secure support for the programme by generating evidence about the innovation, and specifically its clinical effectiveness and broader links to public expectations and experiences of healthcare.

This paper draws lessons from the implementation of The Productive Ward programme in England, which can inform the implementation of other large‐scale programmes of quality improvement in health care.

The purpose of this paper is to explore the nature and impact of leadership in relation to the local implementation of quality improvement interventions in health care organisations.

Using empirical data from two studies of the implementation of The Productive Ward: Releasing Time to Care™ in English hospitals, the paper explores leadership in relation to local implementation. Data were attained from in-depth interviews with senior managers, middle managers and frontline staff (n=79) in 13 NHS hospital case study sites. Framework Approach was used to explore staff views and to identify themes about leadership.

Four overall themes were identified: different leadership roles at multiple levels of the organisation, experiences of “good and bad” leadership styles, frontline staff having a sense of permission to lead change, leader's actions to spread learning and sustain improvements.

This paper offers useful perspectives in understanding informal, emergent, developmental or shared “new” leadership because it emphasises that health care structures, systems and processes influence and shape interactions between the people who work within them. The framework of leadership processes developed could guide implementing organisations to achieve leadership at multiple levels, use appropriate leadership roles, styles and behaviours at different levels and stages of implementation, value and provide support for meaningful staff empowerment, and enable leader's boundary spanning activities to spread learning and sustain improvements.

Recent New Zealand reports have identified the nursing workforce for its potential to make a significant contribution to increased productivity in health services. The purpose of this paper is to review critically the recent and current labour approaches to improve nursing productivity in New Zealand, in a context of international research and experience.

An examination of government documents regarding productivity, and a review of New Zealand and international literature and research on nursing productivity and its measurement form the basis of the paper.

It is found that productivity improvement strategies are influenced by theories of labour economics and scientific management that conceptualise a nurse as a labour unit and a cost to the organisation. Nursing productivity rose significantly with the health reforms of the 1990s that reduced nursing input costs but impacts on patient safety and nurses were negative. Current approaches to increasing nursing productivity, including the “productive ward” and reconfiguration of nursing teams, also draw on manufacturing innovations. Emerging thinking considers productivity in the context of the work environment and changing professional roles, and proposes reconceptualising the nurse as an intellectual asset to knowledge‐intensive health organisations.

Strategies that take a systems approach to nursing productivity, that view nursing as a capital asset, that focus on the interface between nurse and working environment and measure patient and nurse outcomes are advocated.

The paper shows that reframing nursing productivity brings into focus management strategies to raise productivity while protecting nursing and patient outcomes.

The paper problematizes previous research on accountingisation, where the role of accounting in determining the scope of professional work is understood in relation to a professional/economic dichotomy and a model of episodic change. The purpose of this paper is to investigate everyday professional work in established new public management (NPM) settings, and proposes a new conceptual framework to analyze the role of accounting therein. The aim is to enable future investigations into how, when and where a situated “bottom line” emerges, by conceptualizing professional work as a process of calculation.

Qualitative data from case studies of two tertiary level geriatric organizations using observations of 33 employees and four interviews. Data related to patient discharge, and the management of the discharge processes, were analyzed.

Few visible trade-offs between distinctly professional or economic considerations were observed. Rather, the qualification of patients’ status and evaluation of their dischargeability centered on debates over treatment time. Time therefore operated as a situated “bottom line,” to which various other concerns were emergently linked in a process of calculation. Professional practitioners seldom explicitly evoke accounting concepts and technologies, but these were implicated in the ongoing translation of each patient into something temporarily stable, calculable and thus actionable for the professionals involved in their care. The study’s findings have implications for the conceptual understanding of professional work in established NPM settings.

Case study research is context-specific and the role of accounting in professional work will vary due to the professional groups and accounting technologies involved.

The study’s findings have implications for how to influence professional behavior through interventions in the existing landscape of accounting technologies. The possibility to change behavior through the introduction or removal of individual accounting technologies is questioned.

To date, research on the role of accounting in determining the scope of professional work has assumed a professional/economic dichotomy and studied episodic change linked to accounting-oriented reforms. This paper analyses the role of accounting as an on-going process with emergent boundaries between professional and economic considerations.

Productive friction (Ward et al., 2011) can exist as pracademics cross between boundaries of their different identities. Through an exploration of the self-perception of two collaborating pracademics, this paper will consider that organisational and occupational (Evetts, 2009) elements exist that generate professional friction for pracademics.

Using two consecutive Lesson Study cycles as a boundary object, the authors will consider their pracademic identity through a spatial approach. Their perceptions are expressed through semi-structured qualitative interviews and subsequent thematic analysis. This analysis is then explored through Engeström's (2001) learning stages to consider how pracademics interact within the contradictions of their identities and within their context and their work.

Time, purpose, integration and collaboration are all elements that impact on pracademic identities. For each one of these themes, pracademics both experience friction and find resolutions. As these themes vary, there are also moments of unresolved friction, where the pracademics maintain their work based on their enthusiasm alone. Constraints on time and the visibility of pracademic emerge. Exploring these pressure points and their resolutions is key to understanding how pracademics can be further supported by other professionals.

While it is not possible to draw large conclusions from the experiences and perceptions of two primary-school-based pracademics, their experiences and understanding of contextual pressure points may facilitate the support of other pracademics and resonant with their experiences, particularly if they are using Lesson Study.

The purpose of this paper is to underline the importance of taking work practices into account for quality improvement (QI) purposes, highlight some of the challenges of doing so, and suggest strategies for future research and practice. Patient status at a glance, a Lean-inspired QI intervention designed to alleviate nurses of their knowledge mobilisation function, is deployed as an illustrative case.

Ethnographic data and practice-based theories are utilised to describe nurses’ knowledge mobilisation work. The assumptions about knowledge sharing embedded in patient status at a glance white boards (PSAGWBs) are analysed drawing on actor network theory.

There is a disparity between nurses’ knowledge mobilisation practices and the scripts that inform the design of PSAGWBs. PSAGWBs are designed to be intermediaries and to transport meaning without transformation. When nurses circulate knowledge for patient management purposes, they operate as mediators, translating diverse information sources and modifying meaning for different audiences. PSAGWBs are unlikely to relieve nurses of their knowledge mobilisation function and may actually add to the burdens of this work. Despite this nurses have readily embraced this QI intervention.

The study is limited by its focus on a single case and by the inferential (rather than the empirical) nature of its conclusions.

This paper illustrates the importance of taking practice into account in healthcare QI, points to some of the challenges of doing so and highlights the potential of practice-based approaches in supporting progress in this field.

Ward rounds in hospitals are crucial for decision-making in the context of patient treatment processes. However, these tasks are not systematically managed and are often extended due to missing information or equipment or staff unavailability. This research aims to assess whether ward rounds can be structured more efficiently and effectively from the perspective of patients and staff.

This mixed-method approach examines the ward rounds conducted in three units within a haematology department of a major Danish hospital. Baseline measures were collected to capture the value of the ward round described by patients and staff. The information on patient and equipment flows associated with a typical ward round was mapped with recommendations for improvement.

Staff aspired to deliver a good-quality ward round, but what this meant was never articulated and there were no established standards. The duration of the ward round was unpredictable and could take 6 hours to complete. Improvements identified by the team allow the ward rounds to be completed by mid-day with much more certainty.

This research provides an insight as to how ward rounds are conducted within a Danish haematology department.

The research has implications for those involved in ward rounds to reduce the time taken whilst maintaining quality and safety of patient care.

This research has implications for patients and their families who wish to spend time with consultants.

Previous research has focused on the interactions between doctors and nurses. This research focuses on the operational process of the ward round and presents a structured approach to support multi-disciplinary teams with a focus on value from the patient’s perspective.