Background
Methods
Objectives
-
Measuring and comparing the preliminary ‘engagement’ scores from the ward-based teams involved in the national pilot phase of the PW and a control group (of similar size, from similar clinical specialty areas, who were not involved in a quality improvement programme, initiative or improvement activity) [22], as a baseline measure (T1).
-
Measuring and comparing ‘engagement’ scores within both the intervention and control group again approximately 12 months later (T2).
-
Comparing changes in ‘engagement’ scores (T2-T1) in the intervention and control groups, controlling for other variables.
Study design
Setting
PW Site | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | Total |
---|---|---|---|---|---|---|---|---|---|---|
Clinical Specialty | Rehab | Elderly | Surge | Surge | Med | Med | Med | Elderly-Rehab | Med | - |
Numbers Surveyed N = | 20 | 45 | 38 | 27 | 25 | 19 | 28 | 24 | 27 |
253
|
T1 Response Rate N = | 17 (85%) | 43 (95.5%) | 23 (60.5%) | 22 (81.4%) | 9 (36%) | 13 (68.4%) | 19 (65.5%) | 17 (70.8%) | 21 (88.8%) |
180 (71.1%)
|
T2 Response Rate N = | 13 (65%) | 25 (91.3%) | 24 (63.1%) | 17 (62.9%) | 22 (88%) | 7 (36.8%) | 20 (68.9%) | 17 (70.8%) | 24 (88.8%) |
169 (66.8%)
|
T1 & T2 Response Rate N = | 10 (50%) | 24 (53.3%) | 13 (34.2%) | 13 (48.1%) | 4 (16%) | 5 (26.3%) | 9 (32.1%) | 10 (41.6%) | 13 (48.1%) |
101 (39.9%)
|
Control Site |
A
|
B
|
C
|
D
|
E
|
F
|
G
|
H
|
I
|
Total
|
Clinical Specialty |
Rehab
|
Elderly
|
Surge
|
Surge
|
Med
|
Med
|
Med
|
Elderly-Rehab
|
Med
|
-
|
Numbers Surveyed N = |
20
|
42
|
35
|
26
|
24
|
26
|
26
|
24
|
26
|
249
|
T1 Response Rate N = |
18 (90%)
|
18 (42.8%)
|
19 (54.3%)
|
20 (77%)
|
14 (58.3%)
|
22 (84.6%)
|
18 (69.2%)
|
15 (62.5%)
|
14 (53.8%)
|
158 (63.4%)
|
T2 Response Rate N = |
18 (90%)
|
14 (33.3%)
|
20 (57.1%)
|
17 (65.3%)
|
8 (33.3%)
|
26 (100%)
|
20 (76.9%)
|
21 (87.5%)
|
17 (65.3%)
|
161 (64.6%)
|
T1 & T2 Response Rate N= |
15 (75%)
|
13 (31%)
|
5 (14.3%)
|
7 (27%)
|
6 (25%)
|
13 (50%)
|
13 (50%)
|
9 (37.5%)
|
10 (38.4%)
|
91 (36.5%)
|
Participants
-
number of wards/units (n = 9)
-
similar clinical specialty/ward environment
-
similar ward size and sample size
-
consent to participate in the study
-
non-participation in a QI initiative
Grade | Total | |||||||
---|---|---|---|---|---|---|---|---|
Nurse Manager | Staff Nurse | Clerical/Admin | Care Assistant/MT Attendant | Household | ||||
Age
|
18–24 years
| Count | 0 | 13 | 0 | 0 | 0 | 13 |
% within age | 0.0% | 100.0% | 0.0% | 0.0% | 0.0% | 100.0% | ||
25–44 years
| Count | 14 | 140 | 4 | 35 | 1 | 194 | |
% within age | 7.2% | 72.2% | 2.1% | 18.0% | 0.5% | 100.0% | ||
45–65 years
| Count | 15 | 70 | 8 | 34 | 4 | 131 | |
% within age | 11.5% | 53.1% | 6.2% | 26.2% | 3.1% | 100.0% | ||
Total
|
Count
|
29
|
223
|
12
|
69
|
5
|
338
| |
% within age
|
8.6%
|
65.8%
|
3.6%
|
20.5%
|
1.5%
|
100.0%
|
Description sample T2
PW Group |
Percent
|
Control Group
|
Percent
| Total |
Percent
| |
---|---|---|---|---|---|---|
No. Surveyed T2 | 233 |
100%
|
236
|
100%
|
469
|
100%
|
No. Respondents T2 | 169 |
72.5%
|
161
|
68.2%
|
330
|
70.4%
|
No. Respondents T1 & T2 | 101 |
52.6%
|
91
|
47.4%
|
192
|
100%
|
Female | 97 |
96%
|
81
|
89%
|
178
|
92.7%
|
Male | 4 |
4%
|
10
|
11%
|
14
|
7.3%
|
Age: 18–24 | 4 |
4%
|
2
|
2.2%
|
6
|
4.6%
|
Age 25-44 | 56 |
55.4%
|
52
|
57.1%
|
108
|
60.7%
|
Age 45-65 | 41 |
40.6%
|
37
|
40.7%
|
78
|
34.7%
|
Nurse Managers | 9 |
8.9%
|
16
|
17.6%
|
25
|
13%
|
Staff Nurses | 70 |
69.3%
|
61
|
67%
|
131
|
68.2%
|
Clerical/Admin | 1 |
1%
|
2
|
2.2%
|
3
|
1.6%
|
Healthcare Support | 20 |
19.8%
|
11
|
12.1%
|
31
|
16.1%
|
Household | 1 | 1% |
1
|
1.1%
|
2
|
1%
|
Data sources/measurement
-
Vigour refers to high levels of energy and mental resilience while working; the willingness to invest effort in one’s work and persistence even in the face of difficulties
-
Dedication refers to being strongly involved in one’s work and experiencing a sense of significance, enthusiasm, inspiration, pride, and challenge
-
Absorption refers to being fully concentrated and happily engrossed in one’s work whereby time passes quickly and one has difficulties with detaching oneself from work [24].
Statistical methods
Results
T1
Total Sample N = 192
| ||||
---|---|---|---|---|
Time | Engagement Score | Estimated Effect size PW V’s Control | 95% CI |
p-value |
T1 | TES | 0.36 | (0.09, 0.63) | 0.009 |
Vigour | 0.42 | (0.12, 0.72) | 0.006 | |
Absorption | 0.44 | (0.12,0.76) | 0.007 | |
Dedication | 0.43 | (0.11, 0.74) | 0.008 | |
T2 | TES | 0.22 | (−0.03, 0.46) | 0.079 |
Vigour | 0.38 | (0.11, 0.65) | 0.006 | |
Absorption | 0.08 | (−0.20,0.36) | 0.569 | |
Dedication | 0.19 | (−0.09, 0.48) | 0.184 |
T2
'Engagement' scores in PW and control groups at T2 T2
Changes in ‘engagement’ scores from T1 to T2
Total Sample N = 192
| |||
---|---|---|---|
PW Group |
Control Group
|
P value for comparing change between groups | |
T1 & T2 N= | 101 |
91
| - |
TES T1 | 4.39 |
4.07
| |
SD ± | 0.82 |
0.99
| 0.154 |
TES T2 | 4.23 |
4.10
| |
SD ± | 0.85 |
0.88
| |
Vigour T1 | 4.24 |
3.88
| |
SD ± |
0.92
|
1.11
| 0.454 |
Vigour T2 |
4.11
|
3.88
| |
SD ± |
0.92
|
0.99
| |
Absorption T1 | 4.08 |
3.70
| |
SD ± | 1.03 |
1.13
| 0.022 |
Absorption T2 | 4.09 |
4.06
| |
SD ± | 1.04 |
0.88
| |
Dedication T1 | 4.74 |
4.35
| |
SD ±
| 0.85 |
1.22
| 0.071 |
Dedication T2 | 4.53 |
4.42
| |
SD ± | 0.95 |
1.06
|
Discussion
Key results
-
the phased modular content and associated ease of learning QI methods,
-
the local supports associated with the national and structured implementation in Ireland,
-
the perception that this initiative was one of the few development opportunities being offered to staff during an austere-induced drought of development in healthcare in Ireland,
-
the positive impact that the QI tools/methods had on participants levels of professional self-efficacy; which have been recently been identified as a predictor of ‘engagement’ [39].