Healthcare

Delivery Systems
Improvement
Project:
Education and
Training Larissa Gorman, Julia Ni, Kyli
McCorkle-Oblin, Meseret
Patterson, Sobia Zehri
 Overview of Patient Care Delivery
System

● Southern Arizona VA Health Care System

● 3 East Medical- Surgical Floor
● Focus: Education and Training for staff
regarding skin care protocol and reducing the
number of pressure sores developed on the
unit
 Microsystem Model: Leadership
● Manager and Clinical Nurse Leader overall supportive
● Maintain consistency, allow for autonomy, set clear goals,
and build knowledge.
● Address concerns, questions, and opinions.
● Take action to improve quality of care
● Maintain respect for staff members, encouraging
● Democratic leadership “promotes autonomy and growth in
individual workers”
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.).
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Organizational
Culture and Support
● “Larger organization’s values and behaviors contribute to
the microsystem’s environment” - recognition,
information, and resources to enhance nurses’ work
● Huddle every morning
● Managers adopted encouraging attitudes
● Periodic hospital-wide quality improvement meetings

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application
(9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Patient Focus
Patient focus:
● “Care is organized first and foremost around the needs of
patients”
● Nurses took time to actively listen to and address patient
needs - expressed appreciation for the veterans’ service
● Integrative nursing principle #3 - Rose Garden
● Patient handouts
● Evaluated need for invasive interventions (eg. Foley)
● Service flow - slightly disorganized (eg. patient wait time)
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application
(9th ed., p. 366). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Staff Focus
Staff focus:
● “Support education and training of staff to ensure an
adequate skilled workforce”
○ Ongoing, aligns with roles, trains students
● New graduate hires have 1-year orientation
● Quality improvement fair - presentation of measures to
be implemented
● Classes for further training and knowledge
● Premium pay
Marquis, B. L., & Huston, C. J. (2017, p. 376). Leadership roles and management functions in nursing: Theory and
application (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Interdependence
of Care Team
● Interdependence of care focuses on collaboration, trust
and the willingness to help each other
● Staff was very supportive and helpful of each other
● Charge nurse did rounds and assisted those on the unit
● Pharmacist on every unit
● Physicians are easy to approach
● Complications with writing orders
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application
(9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Use of Information and
Healthcare Technology
● Technology allows for effective communication to keep
everyone informed at all times.
● Nurses utilized the internet for information
● CPRS for charting (references for medication information)
● Call lights in full function
● Tele strips available electronically
● Wifi available with no issues
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th
ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Process for
Healthcare Delivery Improvement
● QI models are utilized for continuous improvement quality
efforts
● Quality Improvement Fairs
● Quality Improvement Meetings
-Increase Facility Ratings
-Improving Management & Education
-Adapt New Measurements
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th
ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Staff Performance
Patterns
● Performance appraisal, “implies an appraisal of how
well employees perform the duties of their job as
delineated by the job description”
● Yearly Performance Appraisals
● Focus on Patient Outcomes
-Falls, Foley's, Alarms
● Recommended to apply for new job opportunities
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Specific Aspect Targeted for
Improvement
● Focus on improving education and training regarding
pressure sores
● Unit had more pressure sores compared to other units
● Education would decrease prevalence of pressure sores
● Integrative modality: encourage turning and ambulation
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.).
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Martin D.,Albensi, L. Van Haute S., Froese M., Montgomery M., Lam M., Gierys K., Lajeunesse R., Guse L., Basova N. (2017).
Healthy Skin Wins: A Glowing Pressure Ulcer Prevention Program That Can Guide Evidence-Based Practice.
Worldviews on Evidence-Based Nursing, 14(6), pp. 473-478
 Specific Aspect Targeted for
Improvement (Cont.)
● Evidence-based intervention: online tutorial to teach current
evidence-based methods to prevent, assess, and treat
pressure ulcers
○ Also included info on pathophysiology
○ Powerpoint with voice over and instructional videos
○ 15 minute tutorial
Martin D., Albensi, L. Van Haute S., Froese M., Montgomery M., Lam M., Gierys K., Lajeunesse R., Guse L., Basova N.
(2017). Healthy Skin Wins: A Glowing Pressure Ulcer Prevention Program That Can Guide Evidence-Based Practice.
Worldviews on Evidence-Based Nursing, 14(6), pp. 473-478
 Leading the Plan for Healthcare
Delivery Improvement
● Present to staff:
○ Manager can explain to staff the prevalence of
pressure ulcers
○ Can discuss the effects of PUs on patients, cost for
hospital, etc.
○ Most pressure ulcers are preventable - can be
indicative of quality of health care
Martin D.,Albensi, L. Van Haute S., Froese M., Montgomery M., Lam M., Gierys K., Lajeunesse R., Guse L., Basova N.
(2017)Healthy Skin Wins: A Glowing Pressure Ulcer Prevention Program That Can Guide Evidence-Based Practice.
Worldviews on Evidence-Based Nursing, 14(6), pp. 473-478
 Leading the Plan for Healthcare
Delivery Improvement (Cont.)
● To ensure completion:
○ A $5 gift card to the in-hospital coffee shop
○ Chance to win a $150 gift card to VA shop as
incentives to participate

Martin D.,Albensi, L. Van Haute S., Froese M., Montgomery M., Lam M., Gierys K., Lajeunesse R., Guse L., Basova N.
(2017)Healthy Skin Wins: A Glowing Pressure Ulcer Prevention Program That Can Guide Evidence-Based Practice.
Worldviews on Evidence-Based Nursing, 14(6), pp. 473-478
Timeline of Events
 References
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and
management functions in nursing: Theory and application (9th ed.).
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Martin D., Albensi, L. Van Haute S., Froese M., Montgomery M.,
Lam M., Gierys K., Lajeunesse R., Guse L., Basova N. (2017).
Healthy Skin Wins: A Glowing Pressure Ulcer Prevention Program
That Can Guide Evidence-Based Practice.
Worldviews on Evidence-Based Nursing, 14(6), pp. 473-478