QIP Project: Process

Improvement
Chris Kouris, Cassidy Leroux, Amanda Nguyen, Michael Pautler,
Ryan Tarr

4/24/19
NURS 478/479
Overview of Patient Care Delivery System

Tucson Medical Center: Couplet Care Unit

Focus: process improvement of couplet discharge timeliness

● Exceeds AWHONN “90 minute discharge” window
● Delay in communication between patient, nurse, and
provider

Maurer, P. (2013). Discharge timeliness for mother baby couplets: A six sigma project to improve throughput. Journal of Obstetric, Gynecologic &
Neonatal Nursing, 42, S1-S3. doi: 10.111/1552-6909.12143
Microsystem Model: Leadership
Democratic Leadership: “effective for groups working together
for extended periods of time, promotes autonomy and
growth.”

Charge Nurse roles

Unit Council Meetings

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed., p. 47). Philadelphia,
PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Microsystem Mode: Organizational Culture and
Support
Organizational culture: “the total of an organization’s values,
languages, traditions, customs, and sacred cows.”

Values: “Compassion, Integrity, Dedication, Community”

Support: Docs, VAT team, Lactation, Photographer, Rapid

Response
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed., p. 47). Philadelphia,
PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Mission, Vision & Values. (2019). Retrieved from https://www.tmcaz.com/about-tmc/mission-vision-and-values

 Microsystem Model: Patient Focus & Staff Focus
● Patient Focus:
○ “Putting the patient and the family at the heart of every
decision and empowering them to be genuine partners
in their care”
● Staff Focus:
○ Career coaching: “helping others to identify
professional goals … and designing a career plan to
achieve those goals”
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed., p. 273).
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Interdependence of Care
Team
● “Organizational communication is a high-level
management function; it must be systematic, have
continuity, and be appropriately integrated unto the
organizational structure”
● PCTs, Doctors/NPs, New Grad RNs
● Communication across units
● Culture
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application
(9th ed., p. 491). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Microsystem Model: Use of Information and
Healthcare Technology
● “Technology has dramatically changed how nurses
communicate and perform their work”
● Epic (training provided for all staff/students)
● Pyxis & Barcode scanner for medications
● Computers in room and on hallway walls
● Vocera- voice issues, 24/7 IT or maintenance available
● Call lights directed to clerk who guides patient to RN,
lactation, or charge RN
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed., p. 506). Philadelphia,
PA: Wolters Kluwer Health/Lippincott Williams Wilkins.
 Microsystem Model: Process for Healthcare
Delivery Improvement
● Benchmarking- “the process of measuring products,
practices, and services against best-performing
organizations”
○ LeapFrog scores
○ Ask Mayo Expert ○ Quality Alerts
○ AWHONN ○ Satisfaction surveys
● Meetings
○ Shift huddle ○ Unit council and staff meetings
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed. p. 547).
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Staff Performance Patterns
● “Performance appraisals let employees know the level of
their job performance as well as any expectations that the
organization may have of them”
● Unbiased review of job completed not opinion of RN
● Annual staff RN evaluation from unit manager
● Staff can do a horizontal quality assurance evaluation,
bringing up concerns for patient safety on the floor
● Nurse/PCT of the month
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th
ed., p. 646). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams Wilkins.
 Specific Aspect Targeted for Improvement:
Process Improvement
● Improving discharge timeliness of mother baby couplets
● What TMC is doing currently
○ Discharge nurse (discharge class, only stays until 1500)
○ Discharge only during day shift (anytime)
○ Nurses print out paperwork
○ White board at nurses station listing matches
● Reasons for delayed discharge process
○ Delay in match, labs not done, patient ride is not here,
patient sleeping, no car seat
Specific Aspect Targeted for Improvement Continued
● Effects of late discharge
○ Lack of room for new admits from L+D/antepartum
○ Patient dissatisfaction/ Nurse frustration
● AWHONN goals:
○ Couplets depart from the unit within 90 minutes of an
order match”
● Integrative Nursing is person-centered and relationship based
○ “Nurses work in partnership with patients”
○ Modality: “Anticipate and support needs and preferences”
Maurer, P. (2013). Discharge timeliness for mother baby couplets: A six sigma project to improve throughput. Journal of Obstetric, Gynecologic & Neonatal Nursing, 42, S1-S3. doi:
10.111/1552-6909.12143
Kreitzer, M. J. (2015). Integrative nursing: Applications of principles across clinical settings. Rambam Maimonides Medical Journal, 6(2), 1-8. doi: 10.504/RMMJ.10200
Leading the Plan for Healthcare Delivery Improvement
1. Standardized discharge plan checklist
a. Ensures nurses finish all tasks before/at
discharge (begin with admission from L+D)
2. Patient checklist whiteboards in room (~$4600)
a. Keeps patients informed on plan of care
3. Alerts to OB/pediatrician
a. Decrease match time between both doctors
4. Allow patients choice of discharge time after http://dne2.ucsf.edu/public
/cripc/rd2013/02rdy2go.pd
f
match
Rochester, N. T., Banach, L, P., Hoffner, W., Zeltser, D., Lewis, P., Seelbach, El, & Cuzzi, S. (2018). Facilitating the timely discharge of well newborns by using quality improvement .
. methods. Pediatrics, 141(5) 356-390. Retrieved from https://pediatrics.aappublications.org/content/141/5/e20170872
Karleskind, S. (2013). Ready to go! Patient-centered discharge process improvement. El Camino Hospital of Silicon Valley. Retrieved from http://dne2.ucsf.edu/public/cripc/rd2013/02rdy2go.pdf
Timeline of Events
0-1 1-2 2-3 3 months- 1 year
month months months 1 year

Formulate Education Implementation Evaluate

Analysis
implementation
All staff Install
Gather data on team informed white-boards
Review effects
discharge Review budget Make changes
issues Materials Computer
as necessary
Formulate plan presented notifications

Checklist
References
Karleskind, S. (2013). Ready to go! Patient-centered discharge process improvement. El Camino Hospital of Silicon Valley. Retrieved from
http://dne2.ucsf.edu/public/cripc/rd2013/02rdy2go.pdf

Kreitzer, M. J. (2015). Integrative nursing: Applications of principles across clinical settings. Rambam Maimonides Medical Journal, 6(2), 1-8. doi:
10.504/RMMJ.10200

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.). Philadelphia, PA:
Wolters Kluwer Health/Lippincott Williams & Wilkins.

Maurer, P. (2013). Discharge timeliness for mother baby couplets: A six sigma project to improve throughput. Journal of Obstetric, Gynecologic &
Neonatal Nursing, 42, S1-S3. doi: 10.111/1552-6909.12143

Mission, Vision & Values. (2019). Retrieved from https://www.tmcaz.com/about-tmc/mission-vision-and-values

Rochester, N. T., Banach, L, P., Hoffner, W., Zeltser, D., Lewis, P., Seelbach, El, & Cuzzi, S. (2018). Facilitating the timely discharge of well
newborns by using quality improvement methods. Pediatrics,141(5), 356-390. Retrieved from
https://pediatrics.aappublications.org/content/141/5/e20170872