Healthcare Delivery Systems

Improvement Project
❧ ❧
Daria Schaefer, Alana Mendoza, Vanessa Bustos,
Gabriella Harrington, Ashley Carey

1
 Overview of Patient Care Delivery System

❧ Carondelet St. Mary’s Hospital

❧ Medical intensive care unit (MICU)
❧ Focus: Education and training on skin assessment
to reduce the incidence of skin ulcers

2
 Microsystem Model:
Leadership

❧ Overall: ❧ Interactional leadership

o Well supported by style (Charge RN)
charge RN, unit o Behavior is based off of
manager, and new the leader’s personality
director (perception, abilities) and
o Charge RN/managers the situation.
have open door policy ❧ Transformational
o Quarterly meeting that leadership style (Manager
include CEO, directors, and Director)
and managers: for o “Is committed, has a
quality improvement and vision, and empowers
staff concerns others with that vision”
(Marquis & Huston, 2017, p. 50).
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed., pp. 49-50). Philadelphia: Wolters Kluwer 3
 Microsystem Mode
Organizational Culture and Support
❧ Value of Service: Teamwork and serving others
o “Huddle” every change of shift
o Staff and managers support each other
❧ Value of Quality:
o Communicate desire to improve quality and give
suggestions
o New owners reconstructing: new policies and protocols to
improve quality of care based on front-line clinical units.
❧ Physical Environment:
o Proper resources, safe environmental features, quick
responding maintenance
Carondelet Health Network. (2018). Mission, vision and values. Retrieved from
https://www.carondelet.org/about-us/mission-vision-values
Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in
health care: Part 1. Learning from high-performing front-line clinical units. Jt Comm J Qual Improv, 28(9), 472-493.
4
 Microsystem Model:
Patient Focus

❧ Patient focus:
o 5 core values: quality, integrity, service, innovation,
transparency

o Mission statement: “We are united to help people within

the communities where we serve to live happier and
healthier lives. We provide for the health care needs of our
community; by embracing the whole person in mind, body,
and spirit; and by serving all persons without distinction.
We seek to serve our patients, customers, and our
communities well” (Carondelet Health Network, 2018)
Kreitzer, M. J. (2015). Integrative nursing: application of principles across clinical settings. Rambam
Maimonides medical journal, 6(2), e0016. doi:105041/RMMJ.10200
Carondelet Health Network. (2018). Mission, vision and values. Retrieved from
https://www.carondelet.org/about-us/mission-vision-values 5
 Microsystem Model:
Staff Focus

❧ Staff Focus:
o Mission statement “provide an exceptional
environment for our employees and affiliated physicians”
(Carondelet Health Network, 2018)
o Focus on quality and service
-Bonus pay for covering shifts, holidays, on call
-Rotating float and call off schedule
-Chaplain and chapel available in house

o Integrative Nursing Principle #5

Carondelet Health Network. (2018). Mission, vision and values. Retrieved from
https://www.carondelet.org/about-us/mission-vision-values
6
 Microsystem Model:
Interdependence of Care Team

❧ Daily rounding.
❧ Easy access to providers and all team members of
the interdisciplinary team.
❧ Collaboration of care and goals with patient
and/or family.
❧ “POD’s”

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing:
Theory and application (9th ed., p. 559). Philadelphia: Wolters Kluwer
7
 Microsystem Model:
Use of Information and Healthcare Technology

❧ Real-time documentation
❧ Adequate amount of portable computers on
wheels
❧ Continued education of Cerner updates/reminders
o Monthly CBT’s/Newsletter
o 24/7 IT resources
❧ Binder of hospital and unit policies

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing:
Theory and application (9th ed., p. 512-513). Philadelphia: Wolters Kluwer
8
 Microsystem Model:
Process for Healthcare Delivery Improvement

❧ Daily audits by an RN of all documented care and

procedures
o “an audit is a systemic and official examination of a
record, process, structure, environment, or account to
evaluate performance” (Marquis & Huston, 2017).
❧ Knowledge level assessment
❧ Mandatory bedside reporting
❧ Staff meetings
o However, often inconvenient for night shift nurses and
given late notice for dates and times for all shifts

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing:
Theory and application (9th ed., p. 618). Philadelphia: Wolters Kluwer 9
 Microsystem Model:
Staff Performance Patterns
❧ Daisy award
o “ensure that nurses know how deserving they are of our
society’s profound respect for the education, training,
brainpower, and skill they put into their work, and
especially for the caring with which they deliver their care”
(The Daisy Foundation, 2018).
❧ Comment card for “Above and Beyond” nurses
❧ Monthly statistics for:
o Falls, VAP, CAUTI, Central line infection, C-diff
❧ Protocols for C-diff, hypothermia, stroke (TPA), STEMI’s,
CIWA, heparin, DKA
❧ Dual nurse check for insulin, narcotic drips, narcotic wastes,
heparin doses
The DAISY Foundation. (2018). About DAISY. Retrieved from https://www.daisyfoundation.org/about
10
 Specific Aspect Targeted for Improvement:
Education & Training

❧ Evidence-Based: A single long-term acute care hospital

experience with a pressure ulcer program
o Educating staff about proper skin assessments and care
o 6 pressure ulcers/month down to 0
❧ Unit-Specific Issue:
o Increased incidence of deep-tissue injuries on unit
o Nurses would miss wounds upon initial assessment
o Nurses were consistently not assessing properly
o Injuries went unnoticed for days
Young, D. L., Borris-Hale, C., Falconio-West, M., & Chakravarthy, D. (2015). A single long-term acute care hospital experience
with a pressure ulcer prevention program. Rehabilitation Nursing, 40(4): 224-34. doi: 10.1002/rnj.178
11
 Specific Aspect Targeted for Improvement
(cont.)

❧ Education and Training

❧ Proposed Intervention: Implement online education training
to keep providers up-to-date on proper skin care assessment
and techniques
o Assess pressure ulcer risk upon admission
o Reassess risk regularly
o Inspect skin, especially bony prominences, once a day
o Nutritional support or supplement as needed
o Reposition every 2 hours for immobile patients
o Pressure reducing devices for at risk patients
Young, D. L., Borris-Hale, C., Falconio-West, M., & Chakravarthy, D. (2015). A single long-term acute care hospital
experience with a pressure ulcer prevention program. Rehabilitation Nursing, 40(4): 224-34. doi: 10.1002/rnj.178
12
Leading the Plan for Healthcare Delivery

❧ Presentation of project to staff:

o Provide data of the incidence of pressure ulcers on the
unit (rational-empirical)
o Provide cost-benefit information regarding change
❧ Rational-Empirical Strategy: Assume resistance to change
stems from lack of knowledge
❧ 7.5 hour online education for nurses, 5.5 for PCTs
o Uses a free website, cost associated with hourly wages
(~$52,226, 84 RNs, 41 PCTs)
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in
nursing: Theory and application (9th ed., p. 193). Philadelphia: Wolters Kluwer
Young, D. L., Borris-Hale, C., Falconio-West, M., & Chakravarthy, D. (2015). A single
long-term acute care hospital experience with a pressure ulcer prevention program.
Rehabilitation Nursing, 40(4): 224-34. doi: 10.1002/rnj.178
13
Timeline of Events

2 months 3 months 4 months 6-8 months

Root Committee Program Training

Cause Planning Promotion with Impact
Analysis
Evaluation
20 months end of 20 months

Young, D. L., Borris-Hale, C., Falconio-West, M.,

Implementa Outcomes Education & Chakravarthy, D. (2015). A single long-term
acute care hospital experience with a pressure
ulcer prevention program. Rehabilitation
tion of Evaluation spread to Nursing, 40(4): 224-34. doi: 10.1002/rnj.178

knowledge other Units 14

 References

❧ Carondelet Health Network. (2018). Mission, vision and values. Retrieved from
https://www.carondelet.org/about-us/mission-vision-values
❧ The DAISY Foundation. (2018). About DAISY. Retrieved from
https://www.daisyfoundation.org/about
❧ Kreitzer, M. J. (2015). Integrative nursing: application of principles across clinical
settings. Rambam Maimonides medical journal, 6(2), e0016.
doi:105041/RMMJ.10200
❧ Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management
functions in nursing: Theory and application (9th ed.). Philadelphia: Wolters
Kluwer
❧ Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick,
L. A., & Wasson, J. H. (2002). Microsystems in health care: Part 1. Learning from
high-performing front-line clinical units. Jt Comm J Qual Improv, 28(9), 472-493.
❧ Young, D. L., Borris-Hale, C., Falconio-West, M., & Chakravarthy, D. (2015). A
single long-term acute care hospital experience with a pressure ulcer prevention
program. Rehabilitation Nursing, 40(4): 224-34. doi: 10.1002/rnj.178

15