The ‘Productive Community Services’ Programme: Implementing Change in a Community Healthcare Organisation

The Productive Community Services (PCS) is a change programme which aims to engage frontline healthcare staff in improving quality and productivity. PCS draws on tested improvement methodologies such as Lean, however there has been little research specifically carried out on PCS in practice. The aims of this study were to explore the perceptions of the healthcare staff that implemented the programme, to identify the enabling and constraining contexts of the programme’s mechanisms of change, and to examine the meaningfulness and reliability of quantitative data generated during a PCS implementation. It also sought to explore the implications of these findings for managers, implementation teams, and commissioners in healthcare. To achieve this, an implementation of PCS was investigated using methods of participant observation, analysis of qualitative and quantitative data, semi-structured interviews and a focus group. A mixed methods approach was taken using the principles of Realist Evaluation. The results indicate that perspectives of the implementation varied widely, and that pay-for-performance targets contributed towards staff perceiving that the programme was irrelevant. Stock value was reduced by over £42,500, the time taken to find patient information was reduced by 62%, and services spent on average 36% of their time with patients. However, these figures lacked reliability and meaningfulness as the data were not validated or were produced using apparently flawed experimental designs. Contexts that constrained or enabled the mechanisms of change included staff attitudes, available resources, the effectiveness of communication, and whether technology could be used to resolve problems identified. The findings indicate that managers in healthcare should challenge implementation teams if the purpose of an innovation is unclear, that implementation teams need to be equipped with knowledge about technological solutions to efficiency in healthcare, and Commissioners need to ensure that pay-for-performance targets promote continuous quality improvement rather than temporary solutions.