Healthcare Delivery Systems

Improvement Project

❧ ❧
Stevie Anderson, Sami Dalessio, Mckenna Foxworthy, Molly Hughes, Jacqueline
Jamison
April 18, 2018

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Overview of Patient Care Delivery System

● Carondelet St. Joseph’s

○ Tucson, Arizona

● Progressive Care Unit (PCU)

● Focus: Improve protocols related to short

staffing within the unit

2
Microsystem Model:
Leadership

❧ “Successful leadership: ... teamwork…

empowering others… assists staff… and serves
as a role model”
❧ Carondelet Saint Joseph’s PCU:
o Effective communication
o Successful delegation
o Well-received by other staff

LaCroix, D. (2018). Leadership and management [PowerPoint slides].Retrieved from

www.d2l.arizona.edu
3
 Microsystem Mode
Organizational Culture and Support

● “Shared values, behaviors, and supportive efforts

between members of an organization construct the aura
of the environment and contribute to overall efficacy and
satisfaction”
● PCU:
o Values of the larger organization
o Dedication to the established mission
o Unit-based council meetings (charge, Nurse manager
and staff RNs discuss relevant unit issues)
o Float-pool registered nurses
o On-call registered nurses
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. p. 306). Philadelphia: Wolters Kluwer Health
4
 Microsystem Model:
Patient Focus & Staff Focus
● Patient Focus- “To humanize and personalize the care
of an individual through respect for and incorporation of
his or her unique values and needs.”
■ Advocate patient needs
● Staff Focus- “Healthcare worker job satisfaction has an
impact on motivation, quality, effectiveness, and
commitment to work, therefore setting the tone for the
patient experience.”
■ “Open door policy” from nurse managers
■ Continuing education (tuition reimbursement)
■ Opportunities for advanced practice
Bias, B. (2018). Creating a motivating climate. [PowerPoint slides]. Retrieved from www.d2l.arizona.edu
Janicijevic, I., Seke, K., Djokovic, A., & Filipovic, T. (2013). Healthcare workers satisfaction and patient
satisfaction - where is the linkage? Hippokratia, 17(2), 157-162.
5
Nelson, E., Batalden, P., Huber, T., Mohr, J., Godfrey, M., Headrick, L., & Wasson, J. (2002). Microsystems in health care: Part 1.
Learning from high-performing front-line clinical units. The Joint Commission,28(9), 1-22.
Microsystem Model:
Interdependence of Care Team

“Cohesive teamwork, improved communication between

different levels of healthcare workers, and limited adverse
events improved outcomes, decreased the length of stay
(LOS), and yielded greater patient “staff” satisfaction,”

● Interdisciplinary rounding
● MD’s and providers frequent the unit
● Communication - phone, pagers, & Voceras
● Code team “Rapid Response Team”

Epstein, N. (2014). Multidisciplinary in-hospital teams improve patient outcomes: A review. Surgical
Neurology International, 5(8), 295. doi:10.4103/2152-7806.139612
6
Microsystem Model:
Use of Information and Healthcare Technology

“Technology has dramatically changed how nurses

communicate and perform their work. Younger generations
of nurses, who grew up using computers, cell phones, and
instant messaging, recognize that technology has given us
the potential for instant information access and exchange”
● PCU at St. Joe’s
○ Cerner, Micromedex
○ Tele strips seen on monitor in PCU
○ Call lights/bed alarms unreliable
○ Broken med scanners/malfunctioning Pyxis

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory
and application (9th ed. p. 506). Philadelphia: Wolters Kluwer Health
7
Microsystem Model:
Process for Healthcare Delivery Improvement

● PDSA Model: plan-do-study-act. The cycle is a

“systematic series of steps for gaining valuable learning
and knowledge for the continual improvement of a
product or process”
● Unit Specific
○ Charge nurse researches new evidence based
practices on quality improvement
○ Nurse manager assesses staff and patient concerns
○ With every change on unit comes evaluation such as
gathering staff feedback in monthly meetings
“Section 4: Ways To Approach the Quality Improvement Process.” (2017). Agency for Healthcare Research and Quality.
Retrieved from http://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/index.html
(Bias, B., 2018)
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 Microsystem Model:
Staff Performance Patterns

● Performance appraisals ‘reflect how well

employees perform the duties of their job as
delineated by the job description or some other
prespecified criteria”
● Prevention of CAUTI
● Fall prevention
● Central line infections
● Preventing med errors
● Performance appraisals with nurse manager
● “Breakroom statistics”
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory
and application (9th ed. p. 648). Philadelphia: Wolters Kluwer Health

9
Specific Aspect Targeted for Improvement

● Evidence based: Consequences of inadequate staffing

include missed care, potential failure to rescue and job
stress and dissatisfaction (2016)

● Decrease nurse:patient ratios by implementing New

Graduate RN program on PCU
● By decreasing these ratios missed care (examples),
potential for failure, and job dissatisfaction will be
reduced
● Nurse leadership will move to implement program to
improve inadequate staffing
● Improving nurse:patient ratios positively impacts direct
patient care 10
Specific Aspect Targeted for Improvement
(cont.)

● Leadership
○ Job stress related to short staffing on the PCU
leading to decreased patient outcomes
○ Nurse does not have time to complete tasks
due to improper high patient:nurse ratio

● Charge/Nurse educator
○ present in huddle

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Specific Aspect Targeted for Improvement
(cont.)

12
References

● Bias, B. (2018). Creating a motivating climate. [PowerPoint slides].

Retrieved from www.d2l.arizona.edu
● Epstein, N. (2014). Multidisciplinary in-hospital teams improve patient
outcomes: A review. Surgical Neurology International, 5(8), 295.
doi:10.4103/2152-7806.139612
● Janicijevic, I., Seke, K., Djokovic, A., & Filipovic, T. (2013). Healthcare
workers satisfaction and patient satisfaction - where is the linkage?
Hippokratia, 17(2), 157-162.
● LaCroix, D. (2018). Leadership and management [PowerPoint slides].
Retrieved from www.d2l.arizona.edu
● Marquis, B. L., & Huston, C. J. (2017). Leadership roles
and management functions in nursing: Theory and application (9th ed.)
Philadelphia: Wolters Kluwer Health

13
References cont.

● Nelson, E., Batalden, P., Huber, T., Mohr, J., Godfrey, M., Headrick, L., &
Wasson, J. (2002). Microsystems in health care: Part 1. Learning from
high-performing front-line clinical units. The Joint Commission,28(9), 1-22.
● “Section 4: Ways To Approach the Quality Improvement Process.” (2017).
Agency for Healthcare Research and Quality. Retrieved from
http://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-
approach-qi-process/index.html

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