A revolutionary management system has seen stunning results posted in the first New Zealand hospital ward to trial it.

Called 'Releasing Time to Care - the Productive Ward', the system's key is to let staff design how their ward works.

It follows the management protocols made famous by motor company Toyota, and moulded into a public health model by the United Kingdom's National Health System.

North Shore Hospital's Ward 11, a general medical ward, was the first in New Zealand to roll out the programme, and has now posted its first official results.

Those results show staff vacancies being slashed, from 10 full-time equivalent vacant positions at the system's inception in November last year, to zero vacancies now.

Staff interruptions have been cut by a staggering 88 per cent, from 104 to just 13 per shift. Time spent on inefficient tasks has been reduced, and mountains of unused stock freed up.

The process of getting, administering and documenting a patient's medication has been reduced by an average 47 minutes per shift.

Nurses' administration work has been reduced by 40 minutes per shift.

Shift handovers have been reduced from more than 40 steps to just seven - cutting time spent in handover from 45 minutes to 15 minutes.

The nurses have developed a 'patients' status board', detailing all the essential patient information that would normally only be gained by stopping a nurse and asking.

In all, the changes have 'released' nurses to spend 41 per cent of their time on direct patient contact by October this year, compared to 28 per cent in November 2008. That has effectively added extra nurses to the ward's staff without increasing staffing levels or costs.

Waitemata DHB unit manager, medicine, Marion Dixon, says the dramatic results have come from simple changes. But because nurses' focus has always been primarily on the patient in front of them, those changes weren't investigated, until now.

"Traditionally the nurses have rightly tried to focus all their time on the patient care. But we can't forget that we need to have all the surrounding systems and processes working really well too.

"That's why it's called Releasing Time to Care. The nurses ended up having their time so bound up with inefficient tasks that they didn't have as much time to care as they could have. But this system gives them the opportunity to step back, redesign what's going on in their wards, and make it better."

"Some of the common interruptions are necessary, for the ward to work properly. But 104 per shift is ridiculous. A huge number of them were just a waste of time. What you want is for the process to be as slick as possible."

And as the absence of staff vacancies show, the changes have created an all-round happier ward, Ms Dixon says.

"When I first went onto Ward 11, the nurses all just had their heads down and were writing away furiously. But now, it's just a whole different atmosphere. They're all smiling and happy."

Waitemata DHB will become the first in the country to complete the Releasing Time to Care roll-out, with the system to be underway in all wards of both North Shore and Waitakere hospitals by February 2010.

Timeline: North Shore Hospital began rollout in November 08. Rollout had begun in all North Shore Hospital medical wards by June 09. Rollout will have begun in all North Shore Hospital wards by February 2010.

Waitakere Hospital began rollout in August 09. Rollout will have begun in all Waitakere Hospital wards by February 2010.

Mental health wards began rollout in September 09 Rollout will have begun in all mental health wards by February 2010.

Results from North Shore Hospital's Ward 11 Began rollout in November 2008 (first in New Zealand). Recruitment and retention - gone from 10 FTE nurse vacancies before rollout, to fully staffed within months of rollout. Nurses' direct patient care time increased from 28 per cent in Nov 2008 to 41 per cent in June 2009. Nurses' mid-shift interruptions reduced from 104 per shift to 13. Patient falls reduced by 50 per cent. Shift handover module reduced from more than 40 steps to just seven - reducing time spent in handover from 45 minutes to 15 minutes. Very few patient complaints received since rollout. Changes noted in atmosphere of ward and attitude of staff.

What that means: More time spent on patient hygiene and patient communication. Time spent on medications management decreased by 47 minutes per shift. Nurses' administration work reduced by 40 minutes per shift. No interruptions about location of equipment or information

All wards have been able to reduce stock: Ward 11 identified $3256.44 worth of out of date supplies, which have since been donated to the Pacific Islands. Ward 3 found more than 10,000 unneeded pill pottles in their cupboards, which have been distributed around the medical wards. Ward 6 found more than 4500 plastic aprons, which were transferred to the older-adult wards.