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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.

The purpose of this paper is to investigate the content, purpose and effectiveness of the handover of information between care home staff beginning and completing a shift.

This was an exploratory study drawing on ethnographic methods. A total of 27 interviews with a range of care home staff, including managers, registered nurses, senior care workers and care workers were undertaken in five care homes selected to give a good contrast in terms of size, ownership, shift patterns and type of handover.

Most handovers were short – lasting 15 min or so – and were held in the office or secluded area in which staff could talk privately. They lasted longer in one home in which the incoming and outgoing shifts physically visited each resident’s room and the communal spaces. Staff felt that handovers were important for the efficient running of the home as well as to alert everyone to changes in a resident’s health or important events, such as a hospital appointment. In one home, handheld devices enabled staff to follow a resident’s care plan and update what was happening in real time.

This was a small scale study based on data from a limited number of care homes.

The increasing popularity of 12 h shifts means that many homes only hold two short handovers early in the morning and in the evening when the night staff arrive. There appears to be a trend to reduce the number of staff paid to attend handover. Despite this, handovers remain an important component of the routine of a care home. The information contained in handover relates to the running of the care home, as well as residents’ wellbeing, suggesting that, while their content overlaps with written records in the home, they are not superfluous.

Although the literature on handovers in hospitals is extensive, this appears to be the first published study of handover practices in care homes.