Improving patient well-being in subacute care: a quality improvement initiative.

Individuals experience lower levels of well-being when admitted to hospital. Maximising well-being may lead to improved outcomes for patients and the health service. We aimed to (1) implement co-designed strategies to improve patient well-being on subacute wards, (2) evaluate the well-being levels of the patient cohort before and after implementation and (3) identify barriers and enablers to implementation of strategies. We conducted a quality improvement study with pre-post evaluation across six subacute wards in a tertiary hospital. Data from interviews with patients and meetings between ward staff and management enabled the co-design of strategies to enhance patient well-being. Strategies were prioritised and implemented using plan, do, study, act cycles. Well-being levels were assessed in the cohort using a scale before (n=153) and after (n=145) implementation. A total of 17 strategies to optimise patient well-being were generated; each ward prioritised implementing key strategies relevant to their setting. While intentions to implement the strategies were high, implementation fidelity of strategies varied due to several barriers identified by staff. Well-being levels reported by patients after implementation were not significantly different from those reported by patients before. Despite extensive consultation and co-design of strategies with patients and staff, well-being levels were not improved at the conclusion of the improvement project. Confounders (such as high hospital demand at the follow-up evaluation time) may have impacted results. Suboptimal implementation fidelity may have also reduced the impact of the initiative.