Healthcare Delivery Systems

Improvement Project

Sean Chester, Clay Sensibaugh, Nick Mar, Ivan Urbieta

Overview of Patient Care Delivery System

Tucson

Medical Center

Medical-Surgical

Floor (Unit 850-899)

Focus:

To incorporate an educational session

required by all members of the healthcare team,
that provides evidence based practices to help
reduce and prevent the incidences of falls.
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Microsystem Model:
Leadership
Democratic leadership style: Focus is on mutual
respect and collaboration between the leader
and the people they guide
oCNL, charge nurse and floor nurses collaborate with
one another.
oNurses arent afraid to reach out to charge nurse/CNL
when problems arise.
Gill, E. (2016, January). What is Democratic/Participative Leadership? How Collaboration Can Boost Morale. Retrieved from
http://online.stu.edu/democratic-participative-leadership/

Microsystem Mode
Organizational Culture and Support

The organizational culture uses a team

approach strategy. Fulfilled through:
oTeam huddle pre-shift
oPodding
oTeam works together to achieve common goals (patient focus/staff
focus)

Team focus creates a positive environment on

the unit. Strong support system.
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Microsystem Model:
Patient Focus & Staff Focus

Patient Focus
oBedside report
oNursing leader is present 24/7
oSnacks, beverages, and food present 24/7
(Dial 4-1111, option 2)
oPatient care technicians and nurses round
hourly to communicate information to patients.

Tucson Medical Center (2016). Unit 850 Welcome Letter. [Brochure]. Tucson, Arizona: TMC.
Tucson Medical Center Charge Nurse, personal communication, 2016.

Microsystem Model:
Patient Focus & Staff Focus

Staff Focus
oEmphasis on personal wellness/self-care
(reimbursement programs for gym
memberships)
oContinuing education available (tuition
reimbursement programs)
oNew Graduate Program

Tucson Medical Center (2016). Unit 850 Welcome Letter. [Brochure]. Tucson, Arizona: TMC.
Tucson Medical Center Charge Nurse, personal communication, 2016

Microsystem Model:
Interdependence of Care Team

Definition: A dynamic process involving two or

more health professionals with complementary
backgrounds and skills...

Location of offices/desks
Slow physician rounding/response
Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary team work.
Human Resources for Health Hum Resour Health, 11(1). doi:10.1186/1478-4491-11-19

Microsystem Model:
Use of Information and Healthcare Technology
Technology helps improve patient safety and health care quality through
improving the adherence to guidelines, enhancing disease surveillance, and
decreasing medication errors during administration.

Healthcare technology on the unit:

oEpic-Electronic Health Record
oVocera-staff communication
oCall lights in patient rooms-linked to phone at units
main desk
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Cassano, C. (2014). The Right Balance Technology and Patient Care. Retrieved from http://www.himss.org/right-balance-technology-and-

Microsystem Model:
Process for Healthcare Delivery Improvement

Overall, these were the systems in place to help

improve healthcare delivery...
o Benchmarking (compared unit to other med-surg units at
TMC & hospitals in town)
o Educational sessions during New Graduate Program
o Bulletins on unit & in staff bathrooms with Evidence Based
Practice Articles
o CNL delivers process improvement techniques during
huddle
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Microsystem Model:
Staff Performance Patterns
Focuses on the following: positive patient outcomes, quality of care,
practice standards, reflection of performance during team huddles.
Evaluation methods:
o Charge Nurse follows nurses during handoff with assessment
tool
o Anonymous staff recognition box
o During huddle there is an open discussion for positive and
negative feedback
Incentives:
Christmas Bonuses
Unit food parties for meeting specific goals (falls, HAIs, etc) 10

Specific Aspect Targeted for Improvement

Goal: Reduce the total number of falls on the

850 Med-Surg unit at TMC through staff nurse
education

Rationale: Falls remain one of the top adverse

events within the hospital setting. They are also
frequently associated with high morbidity and
mortality.
Institute for Healthcare Improvement. (2016). Falls Prevention. Retrieved from
http://www.ihi.org/topics/Falls/Pages/default.aspx

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Leading the Plan for Healthcare Delivery

Improvement
Our focus is to use the Plan-Do-Study-Act (PDSA) Model
to guide our improvement project and to test the
effectiveness of our proposed educational sessions
oThree fundamental questions
1. What are we trying to achieve?
2. How will we know that a change is an improvement?
3. What change can we make that will result in an improvement?

oPDSA Cycle
Langley, G. L., Nolan, K. M., Nolan, T. W., Morman, C. L., & Provost, L. P. (2009). The Improvement Guide: A Practical Approach to
Enhancing Organizational Performance (2nd Edition). Retrieved from
http://www.ihi.org/resources/Pages/Publications/ImprovementGuidePracticalApproachEnhancingOrganizationalPerformance.aspx

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Model for Improvement

Aim: Reduce the number of falls on the 850 unit by 25% within 1 year.
o Current goal: Reduce controllable falls by 12.5% for 2016
Current fall rate: 6.3 falls per 1000 patient days
o We will establish a team comprised of interprofessionals
Establishing measures:
o Quantitative analysis on number of falls (monthly)
o Survey family members
Change concepts:
o Implementation of patient care delivery system focus (educational
sessions)
Testing Changes
o Use the PDSA
Implement and Spread Changes
o Dependant upon success of educational intervention

Plan-Do-Study-Act
PLAN
Use evidence-based fall risk education to reduce risk and ensure patient safety from falls in unit 850
through promoting nurses to educate patients and their families to take a more active role in
reducing falls in a one year timeframe.
DO
Hold meetings at start of year that occur on second Tuesday of every month
Distribute surveys to patients upon admission and nurses to assess knowledge of fall risk and
interventions
Document problems, unexpected effects and general observations as needed.
STUDY
Complete the analysis of our staff and family surveys, review quantitative data on quarterly falls.
ACT
Refine changes based upon areas of strengths and weaknesses, along with feedback from nurses
and families.

References
Cassano, C. (2014). The Right Balance Technology and Patient Care. Retrieved from http://
www.himss.org/right-balance-technology-and-patient-care
Gill, E. (2016, January). What is Democratic/Participative Leadership? How Collaboration Can Boost
Morale. Retrieved from http://online.stu.edu/democratic-participative-leadership/
Institute for Healthcare Improvement. (2016). Falls Prevention. Retrieved from http://www.ihi.org/
topics/Falls/Pages/default.aspx
Langley, G. L., Nolan, K. M., Nolan, T. W., Morman, C. L., & Provost, L. P. (2009). The Improvement
Guide: A Practical Approach to Enhancing Organizational Performance (2nd
Edition).
Retrieved from http://www.ihi.org/resources/Pages/PublicationsImprovement
GuidePracticalApproachEnhancingOrganizationalPerformance.aspx
Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of
good interdisciplinary teamwork. Human Resources for Health Hum Resour Health, 11(1).
doi:10.1186/1478-4491-11-19
Opsahl, A. G., Ebright, P., Cangany, M., Lowder, M., Scott, D., & Shaner, T. (2016). Outcomes of
Adding Patient and Family Engagement Education to Fall Prevention Bundled Interventions. Journal
of Nursing Care Quality, 1. doi:10.1097/ncq.0000000000000232

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Reference
Tucson Medical Center (2016). Unit 850 Welcome Letter. [Brochure]. Tucson, Arizona: TMC.
Tucson Medical Center Charge Nurse, personal communication, 2016