Healthcare Delivery Systems

Improvement Project

Kailey Jones

Overview of Patient Care Delivery System

XX Hospital

X Intensive Care Unit (XICU)

Focus: Patient Focus related to Medication

Education

Microsystem Model:
Leadership

Leaders balance settings and strive to reach

collective goals while empowering staff as
individuals while encouraging autonomy and
accountability.

A good leader:
o Maintains constancy of purpose
o Fosters respective culture and safety culture
o Builds knowledge, review and reflects
3

Microsystem Model:
Organizational Culture and Support

The culture XICU organization is to some extent

inconsistent in the support and framework of the
microsystem to facilitate in coordinating the
microsystem

A good organizational culture:

oLooks for ways to support the microsystem
oCoordinates handoffs between microsystems
oSupportive
4

Microsystem Model:
Patient Focus & Staff Focus

XICU Nurses: have specific trained quality care

skills. Expectations of the staff are high
regarding performance, continuing education
and professional growth

Orientation is rigorous for new staff members

Float pool nurses: under-qualified care & less

cohesive environment
5

Microsystem Model:
Interdependence of Care Team

The interaction of staff is characterized by trust,

collaboration, willingness to help each other,
appreciation of complementary roles, respect
and recognition that all contribute individually to
a shared purpose (Nelson, 2002).
o Doctor-nurse interactions are harmonious
o Nurse-nurse relationships are conflicting
o Management has adequate communication
with staff

Nelson et al. (2002) Microsystems in Healthcare: Part 1. Learning from high performing front- line clinical
units. Joint Commission Journal on Quality Improvement, 28 (9). 472 493. PMID: 12216343 -http://lsatqdm.qdmnet.com/qdm/microsystems/JQIPart1.pdf

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.
Most of the time I have the information I need, but sometimes
essential information is missing and I have to track it down.
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.

Foster, T.C., Johnson, J.K., & Baltalden, P.B. (2007). Using a Malcolm Baldrige framework to understand high-performing clinical
Microsystems. Quality and Safety in Health Care, 16, 334-341. Doi: 10.1136/qshc.2006.020685
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464977/

Microsystem Model:
Process for Healthcare Delivery Improvement
There are ample resources to support continual
improvement work. Studying, measuring and improving
care in a scientific way are essential parts of our daily
work.
Ideas of change are implemented with adequate
discipline and are supported through management
leadership

Foster, T.C., Johnson, J.K., & Baltalden, P.B. (2007). Using a Malcolm Baldrige framework to understand high-performing clinical
Microsystems. Quality and Safety in Health Care, 16, 334-341. Doi: 10.1136/qshc.2006.020685
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464977/
Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application (8th ed,

Microsystem Model:
Staff Performance Patterns

Performance focuses on patient outcomes,

avoidable costs, streamlining delivery, using data
feedback, promoting positive competition, and frank
discussion about performance (Nelson, 2002).
o Patient outcomes are evaluated by management
o Changes are incorporated into the unit/hospital

structure based on data

Nelson et al. (2002) Microsystems in Healthcare: Part 1. Learning from high performing front- line clinical units.
Joint Commission Journal on Quality Improvement, 28 (9). 472 493. PMID: 12216343 -http://lsatqdm.qdmnet.com/qdm/microsystems/JQIPart1.pdf

Specific Aspect Targeted for Improvement

Patient Focus related to Medication Education

Key Positive Impacts:

oKeep patient and family informed during
oPrevent or early detection of common/noncommon adverse side effects
oImprove health literacy
oRetained information upon discharge;
continuity of care
oSelf-advocacy
10

Specific Aspect Targeted for Improvement

(cont.)
Potential

Negative Impacts:
oLess Medication Teaching- Reliance
oAssuming Reading Levels
oNot All Cultures Considered

1-3 months

3-5 months

6-12 months

12 months

18 months

24 months

Research most
commonly used
drugs in XICU,
create cards
and have cards
translated into
Spanish.

Present idea to
nursing staff of
XICU. Print
exemplar cards
to be posted in
the units.

Post cards in
each room of
the unit.
Disperse
surveys to
nursing staff,
patients, and
patient family
members

Evaluate the
use of the cards
based on the
surveys
completed by
nursing staff,
patients and
patient family
members.

If necessary,
make changes
to cards.
Present idea to
nursing staff in
other units of
the Banner
Hospital
System.

Implement
intervention
hospital-wide.
Continue to
evaluate cards
and make
changes as
necessary.

11

Leading the Plan for Healthcare Delivery

Improvement
Implementation of Patient Medication Education Cards
Medication Card Education
o Assess: Identify common medications on the unit
including most cardiac drugs

o Planning: Create medication cards in English and

Spanish for each room on the unit

o Implementation: Nurses undergo a continuing

education course that provides patient teaching
medication cards upon admission to all patients

o Evaluation: Conduct exit survey of patient families12

References
Foster, T.C., Johnson, J.K., & Baltalden, P.B. (2007). Using a
Malcolm Baldrige framework to understand high-performing
clinical Microsystems. Quality and Safety in Health Care, 16, 334341. Doi: 10.1136/qshc.2006.020685
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464977/
Institute for Healthcare Improvement. (2016). 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.547). Philadelphia,
PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
Nelson et al. (2002) Microsystems in Healthcare: Part 1. Learning
from high performing front- line clinical units. Joint Commission
Journal on Quality Improvement, 28 (9). 472 493. PMID:
12216343 -http://lsatqdm.qdmnet.com/qdm/microsystems/JQIPart1.pdf

13