Can I just ask whether anyone has utilised any particularly innovative/successful methods in facilitating clinical areas where Releasing Time to Care progress has slowed down or stopped? We have had some successes and utilise a range of methods, but would welcome any shared learning from other areas in trying to crack some particularly tough cases.

Hi Geoff

I am implementing the Productive Community Services (PCS) programme and have faced similar challenges - I've also spoken to different people from across the country who are also in the same boat - so it's not just you.

Depends on the reasons why progress has slowed/stopped. I'd make sure I was clear on whether this was due to front line staff issues such as half the team are on maternity leave or if it was a wider issue such as lack of engagement from senior managers. I suspect there will be multiple reasons why. Once you identify the root causes, you can put in plans to counter each one.

Translating changes for staff is really important so that they can see how to implement changes without having to make too much mental effort. Currently I am having to stress to staff that most of what the PCS programme includes relates to work they are already doing, the Productives just asks staff to approach what they are doing with 'Productive eyes' as it were - this counters the impression that the Productives is a massive insurmountable project that they don't have time for.

With the Knowing how we're doing module I'm suggesting to teams that they change meeting agendas so that all items fit under one of the four quadrant headings (Pt Safety & Reliability; Pt Experience, Productivity and Staff Well being) so that the concept becomes embedded into what they already do and staff gradually get the hang of being more organised with their meetings to release time to care.

I've also heard from organisations who have linked completion of Productive modules to the appraisal process and also have a sign off process with a nominated Director as each module is completed - this all depends on how engaged your exec team are, of course.

The bottom line for me is that maintaining engagement with change is like juggling multiple balls at once and you can't do it on your own - you need wider support and properly governed programme management. Plus you have to keep re-visiting the same tactics to keep the momentum going which can be really hard work if you don't have much support.

For quick reference try reading guidance on 'Sustaining Momentum' and 'Reviving a Stalled Effort' which can both be found in The Handbook Of Quality And Service Improvement Tools (look on the NHS Institute web site) and read through the NHSI Sustainability Guide if you haven't already done so to undertsand better what needs to be in place for your programme to be successful. Also, Helen Bevan's Expert on Call sessions, Productivity in Challenging Times Parts 1 & 2, are very inspiring and help focus you on what exactly needs to be in place to maintain staff engagement and ensure sustainable long term change (http://www.institute.nhs.uk/nhs_alert/expert_on_call/expert_on_call.html?utm_source=Sign-Up.to&utm_medium=email&utm_campaign=-).

There is lots of information out there about why projects fail and they are all bound up with how change is implemented and whether sustainability mechanisms have been put in place.

Hope this gives you some quick wins.