Healthcare Delivery Systems

Improvement Project

Stefany Barriga, Sara Dacquisto, Chelsey Earnhart, Suzanna Jeffries, Marissa Lizarraga
December 2, 2015

Overview of Patient Care Delivery System

Discuss: Hospital and selected unit

Focus: Performance Patterns related to Nurse-Patient
Ratio

Microsystem Model:
Leadership

Leaders struggle to find the right balance between

reaching performance goals and supporting and
empowering the staff.
Authoritarian leadership
Centralized
RN feedback not valued

Marquis, B.L., & Huston, C.J. (2015b). Leadership roles and management functions in nursing theory
and application (8th
ed., pp. 40-41). Philadelphia, PA:Wolters Kluwer health/ Lippincott Williams & Wilkins.

Microsystem Model:
Organizational Culture and Support

Inconsistent and unpredictable in providing

recognition, information, and resources needed to
enhance the nurses work
Fear of communication with organizational leaders
Limited information sharing amongst levels of
hierarchy
Limited fiscal and human resources to support change

Marquis, B.L., & Huston, C.J. (2015c). Leadership roles and management functions in nursing theory and
application (8th ed., pp. 260-286). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx

Microsystem Model:
Patient Focus & Staff Focus

Patient Focus
o Provide care that is respectful of and responsive to
individual patient preferences, needs, and values,
and ensuring that patient values guide all clinical
decisions
o Patient Centered Care - Nurses, Patient
Ambassadors
Staff Focus
o An organization ...is responsible in part for the
growth in staff development programs.
o Continuing Education - Unit Specific

Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and
application (8th ed., pp. 366). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams &
Wilkins.
Warren, N. (2012). Involving patient and family advisors in the patient and family-centered care model.

Microsystem Model:
Interdependence of Care Team

Care is provided by an interdisciplinary team

characterized by trust, collaboration, appreciation of
complementary roles, and a recognition that all
contribute individually to a shared purpose
Unit team provides effective interdisciplinary teamwork
o Medics, Nurses, and Doctors

Youngwerth, J., & Twaddle, M. (2011). Cultures of interdisciplinary teams: How to foster good dynamics.
Journal of palliative medicine, 14(5), 650-654. doi: 10.1089/jpm.2010.0395
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx

Microsystem Model:
Use of Information and Healthcare Technology

Patients have access to standard information that is

available to all patients- weve started to think about
how to improve the information they are given to better
meet their needs
Technology facilitates a smooth linkage between
information and patient care by providing timely,
effective access to a rich information environment-the
information environment has been designed to support
the work of the clinical unit.

Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
Marquis, B.L., & Huston, C.J. (2015d). Leadership roles and management functions in nursing theory and
application (8th ed., pp. 452-456). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams &
Wilkins.

Microsystem Model:
Process for Healthcare Delivery Improvement

Benchmarking is the process of measuring products,

practices, and services against best-performing
organizations.
Improvement projects implemented
o Not taken seriously

Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and
application (8th ed., pp. 547). Philadelphia, PA: Wolters Kluwer health/Lippincott Williams &
Wilkins.

Microsystem Model:
Staff Performance Patterns

We often collect data on the outcomes of the care we

provide and on some processes of care.
Research indicates that patient safety is linked to
nurse staffing.
Lower patient-nurse ratio markedly improves patient
outcomes in a good work environment
Safe staffing is linked to lower rates of readmission
because RNs are able to spend more time on patient
education

Blegen, M. A., Goode, C. J., Spetz, J., Vaughn, T., & Park, S. H. (2011). Nurse Staffing effects on patient
outcomes: Safety-net and Non-safety-net hospitals. Medical Care, 49(4), 406-414.
Twigg, D., Duffield, C., Thompson, P. L., & Rapley, P. (2010). The impact of nurses on patient morbidity
and mortality - the need for a policy change in response to the nursing shortage. Australian Health
Review, 34(3), 312-316.

Specific Aspect Targeted for Improvement

Organizational changes have resulted in unit changes

Budget cuts: Staffing and Increased nurse-patient ratio
Studies found
o Increased length of stay and wait times
o Increased mortality rates and unit related
complications
Goal: Decrease adverse patient outcomes and
mortality

Blegen, M. A., Goode, C. J., Spetz, J., Vaughn, T., & Park, S. H. (2011). Nurse Staffing effects on patient
outcomes: Safety-net and Non-safety-net hospitals. Medical Care, 49(4), 406-414.
Chan, T. C., Killeen, J. P., Vilke, G. M., Marshall, J. B., & Castillo, E. M. (2010). Effect of mandated nurse
patient ratios on patient wait time and care time in the emergency department. Academic
Emergency Medicine, 17(5), 545-552.
Shekelle, P. G. (2013). Nurse-patient ratios as a patient safety strategy. Annals of Internal Medicine,
158(5), 404-410.
Twigg, D., Duffield, C., Thompson, P. L., & Rapley, P. (2010). The impact of nurses on patient morbidity
and mortality - the need for a policy change in response to the nursing shortage. Australian Health

Leading the Plan for Healthcare Delivery

Improvement

National Safe Patient Ratio Bills

Literature: increased RN staffing is cost-effective. But,
low recognition among organizational leaders of RNs
impact on patient safety
Two year timeline
Morale
3-5 mo

Education
6-12mo

Hiring
12mo

Eval
18mo

House-wide
24mo

National Nurses United (2015). National campaign for safe RN-to-patient staffing ratios. Retrieved from
http://www.nationalnursesunited.org/issues/entry/ratios
Marquis, B.L., & Huston, C.J. (2015a), Leadership roles and management functions in nursing theory and
application (8th ed., p. 8). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
Twigg, D., Duffield, C., Thompson, P. L., & Rapley, P. (2010). The impact of nurses on patient morbidity
and mortality - the need for a policy change in response to the nursing shortage. Australian Health
Review, 34(3), 312-316.

References
Blegen, M. A., Goode, C. J., Spetz, J., Vaughn, T., & Park, S. H. (2011). Nurse staffing effects on
patient outcomes: Safety-net and non-safety-net hospitals. Medical Care, 49(4), 406-414.
Chan, T. C., Killeen, J. P., Vilke, G. M., Marshall, J. B., & Castillo, E. M. (2010). Effect of mandated
nursepatient ratios on patient wait time and care time in the emergency department. Academic
Emergency Medicine, 17(5), 545-552.
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory
and application (8th ed., pp. 8, pp. 40-41, pp. 260-286, pp. 366, pp. 452-456, pp. 547).
Philadelphia, PA: Wolters Kluwer health/Lippincott Williams & Wilkins.

References
National Nurses United (2015). National campaign for safe RN-to-patient staffing ratios. Retrieved
from http://www.nationalnursesunited.org/issues/entry/ratio
Shekelle, P. G. (2013). Nurse-patient ratios as a patient safety strategy. Annals of Internal Medicine,
158(5), 404-410.
Twigg, D., Duffield, C., Thompson, P. L., & Rapley, P. (2010). The impact of nurses on patient
morbidity and mortality - the need for a policy change in response to the nursing shortage.
Australian Health Review, 34(3), 312-316.
Warren, N. (2012). Involving patient and family advisors in the patient and family-centered care
model. MEDSURG Nursing, 21(4), 233-239.
Youngwerth, J., & Twaddle, M. (2011). Cultures of interdisciplinary teams: How to foster good
dynamics. Journal of palliative medicine, 14(5), 650-654. doi: 10.1089/jpm.2010.0395