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What happens when the chair changes: our QI projects with NHS wards

Written by Tristan Hulbert, Vivid.Care. Author of “The Healthcare Professional’s Complete Guide to Specialist Seating Assessments”. Last updated: 3 August 2026.

The harms of immobility are well evidenced. The contribution of the chair isn’t. There are no randomised trials showing that any specific ward chair changes deconditioning outcomes, ours included. So we’re running quality improvement projects with NHS wards to measure what actually happens to sit-out rates, sit-out duration and time to first mobilisation when the seating changes. The ward keeps the data and the authorship, and we publish what we find either way, including null results.

The gap we are trying to close

Here’s the argument as it usually gets made in this market:

  1. Immobility in hospital causes measurable harm. Well evidenced.
  2. Older inpatients spend a median of 83% of measured time lying down, and most of them can walk (Brown, JAGS 2009). Well evidenced.
  3. Discomfort, pain and fatigue are among the documented reasons patients don’t get up (Brown, Journal of Hospital Medicine 2007). Well evidenced.
  4. Therefore a chair a patient can tolerate for longer produces more time out of bed, and better outcomes. Not evidenced.

Step four is inference. It’s reasonable inference and we believe it, but believing something isn’t the same as having shown it. We’d rather go and find out.

Over time this should become the most useful page on the site, because it will hold the one thing nobody in this market currently has: real-world NHS data on what happens to mobility when the seating changes.

What we measure

Five measures, agreed before anything changes

All five are collected by the ward, on the ward, using definitions agreed at the start. Baseline first, then intervention, then follow-up.

Sit-out rate

A point-prevalence count at a fixed time each day: patients out of bed as a proportion of patients on the ward.

Sit-out duration

Minutes out of bed per patient per day. A high sit-out rate lasting fifteen minutes each isn't a success.

Time to first mobilisation

Hours from admission to the first documented period out of bed. Most of the avoidable loss happens here.

Staff-reported handling burden

How many staff, and how long, a transfer takes. Collected by short structured survey rather than observation.

Patient-reported comfort

Rated comfort and willingness to sit out again, collected directly from patients.

How it works

Three stages, and the ward is in charge of all of them

1

Baseline, before anything changes

The ward measures its current sit-out rate, duration and time to first mobilisation for an agreed period, usually two to four weeks, using its existing seating. We help design the data collection and provide the tooling. Nothing gets supplied and nothing changes until the baseline exists, because a project without a baseline can't produce a usable result.

2

Intervention and measurement

We supply the seating and support the measurement. The ward carries on collecting the same five measures using the same definitions. We don't collect the data ourselves, we don't hold it, and we can't select which parts of it get reported.

3

Write-up and publication

We support analysis and write-up. The ward keeps the data and the authorship. Results get published here and offered for submission to BMJ Open Quality or as a BGS poster, with the ward team as authors.

Our commitment on null results

If a project shows no improvement, or shows things getting worse, we will publish it on this page with the same prominence as a positive result.

It’s in writing here so you can hold us to it.

Publication bias is a real problem in this field. If the only projects that ever appear are the ones that worked, the collection is worthless as evidence no matter how carefully each individual project was run.

We’d also genuinely rather know. A negative result would tell us something useful about where the chair does and doesn’t matter, and we’d much rather learn that from a QI project than from a customer three years into a contract.

What these projects can and cannot show

The limits of quality improvement methodology, which we state in every write-up.
What a QI project of this kind can establish What it cannot establish
Design Before and after change in measured behaviour on a real ward, using the ward’s own definitions and staff. Causation. There’s no control ward and no randomisation, so other changes during the period can’t be excluded.
Effect Whether sit-out rates and duration moved, and by how much, in this setting. Whether the seating caused the movement, as opposed to the attention the project brought with it.
Generalisability A description detailed enough for another ward to judge whether it resembles theirs. That the same result would happen elsewhere. Single-site QI doesn’t generalise on its own.
Outcomes Process measures, including time out of bed, plus staff and patient experience. Patient outcomes such as length of stay, falls or pressure ulcer incidence. Those need far larger samples than one ward provides.

The Hawthorne effect is worth naming specifically. Measuring sit-out rates on a ward tends to increase sit-out rates, regardless of what the patients are sitting on. Any project like this will contain some of that, and we say so in every write-up.

Who is taking part

Participating wards get named here as and when they consent to be named, with the trust’s communications team involved. We won’t name anyone who hasn’t agreed in writing, and a ward can withdraw consent at any point.

Current status, as of 3 August 2026: recruiting. No projects have completed and no results are available yet. This section gets updated as soon as that changes, and the date above will move with it.

Results

None yet. When results exist they’ll appear here in full, including the baseline period, the definitions used, the number of patients, the confidence limits, the limitations, and the direction of the finding.

Each completed project will also become a BGS poster or a BMJ Open Quality submission with the ward team as authors, a case study, and a section on the main deconditioning guide.

How to take part

The projects that work best start with a ward team that already wants to change something, rather than with a supplier looking for a site. If you’re already thinking about your sit-out rates, you’re exactly the right kind of partner.

  • Run the audit first. Use the free sit-out audit tool for a week. No sign-up, no email gate, and no data leaves your browser. If the numbers surprise you, you’ve got a project.
  • Talk to your QI or clinical audit team early. Most projects like this sit within service evaluation or QI governance rather than needing research ethics approval, but that’s your organisation’s call.
  • Then get in touch. Contact us through the contact page and say you’re interested in the deconditioning QI programme.

We’ll say no to projects we don’t think can produce a usable result. A badly designed project that produces a flattering number is worse than no project at all.

Related reading

Common questions

QI projects: common questions

What exactly are you measuring?

Five things: sit-out rate as a daily point-prevalence count, sit-out duration in minutes per patient per day, time from admission to first documented mobilisation, staff-reported manual handling burden, and patient-reported comfort and willingness to sit out again. All five get defined with the ward before the baseline period starts, and the definitions don’t change afterwards.

Sources

  1. Brown CJ, Redden DT, Flood KL, Allman RM. The underrecognized epidemic of low mobility during hospitalization of older adults. Journal of the American Geriatrics Society, 2009;57(9):1660-1665.
  2. Brown CJ, Williams BR, Woodby LL, Davis LL, Allman RM. Barriers to mobility during hospitalization from the perspectives of older patients, their nurses and physicians. Journal of Hospital Medicine, 2007;2(5):305-313.
  3. NHS England. Model discharge pathway, publication reference PRN02543, 7 July 2026.
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