Quality Improvement Project:

Healthcare Delivery

Jacob Early, Duncan Shaw, Daniel Hermosillo, Alejandro Dominguez
& Cadence Williams

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Overview of Patient Care Delivery System

Analyze current charting system and implement

streamlined charting protocols to avoid entry
redundancies by improving existing charting
software.

Banner University Medical Center

- Surgical/ Trauma ICU
- Focus: Use of information technology

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Microsystem Model:
Leadership

Decentralized decision making diffuses decision

making throughout the organization and allows
problems to be solved by the lowest practical
managerial level.

Leadership of the Trauma/Surgical ICU

o Democratic Leadership
o Decentralized Decision Making
o RN Feedback Highly Valued
Marquis, B.L., & Huston, C.J. (2015b). Leadership roles and management functions in nursing theory and application
(8th ed., p. 273). Philadelphia, PA:Wolters Kluwer health/ Lippincott Williams & Wilkins.
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Microsystem Model
Organizational Culture and Support

Resources are readily available and teamwork is

utilized between nurses and other
interdisciplinary team members.

- Communication is strongly encouraged

- Teamwork allows for safe patient care
- Impact: Effective, safe and timely and overall
improved delivery of care.
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx

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Microsystem Model:
Patient Focus & Staff Focus

Patient Focus
- Making health care easier so life can be better
- Provide safe quality care that is patient
centered

Staff Focus
- Staff input valued for patient assignments
- Continuing Education is recommended
- ACLS, CRRT, CCRN, Ultrasound IV

Banner Health. (2017). Our non-profit mission. Retrieved from https://www.bannerhealth.com/about/mission. Accessed on November 27,2017.

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Microsystem Model:
Interdependence of Care Team

We will be a national leader recognized for

clinical excellence and innovation, preferred for
a highly coordinated patient experience, and
distinguished by the quality of our people

Interdisciplinary Members
- RNs, MDs, RTs, OTs, PTs, PCTs
o Interdependence between health care team

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Microsystem Model:
Use of Information and Healthcare Technology

MyBanner HealtheLife - Patient access

Cerner - Recent switch from EPIC

Electronic Charting Benefits

- Access to information
- Safety checks

Electronic Charting Negatives

- Less time spent with patients
- Task oriented vs. Patient oriented
Banner Health. (2017). MyBanner/MyChart Patient Portal. Retrieved from
https://www.bannerhealth.com/patients/mybanner-patient-portal
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Microsystem Model:
Process for Healthcare Delivery Improvement

Benchmarking
Dual RN sign off for CLABSIs

Current Improvement Projects

- 4 hour oral care vs 2 hour oral care
- Curos caps on all central lines
- Is the Foley still necessary?

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Microsystem Model:
Staff Performance Patterns

Excessive nursing workload was the main risk

factor for HAI, when evaluated together with
other invasive devices such as those in an ICU.

Has staff performance changed since Cerner

- Staff attitudes
- Time management
- Patient safety

Daud-Gallotti, R. M., Costa, S. F., Guimares, T., Padilha, K. G., Inoue, E.N., & Vasconcelos, T.N. (2012). Nursing workload as a risk factor for
healthcare associated infections in ICU: A prospective study. Retrieved from: https://doi.org/10.1371/journal.pone.0052342
Specific Aspect Targeted for Improvement

Going from a Porsche to a Pinto

UMC Banner UMC
- Switch to Cerner from Epic
- charting patient time

Goal: Decrease amount of time spent charting

on repetitive information. Chart by exception to
increase time at patient bedside.

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Leading the Plan for Healthcare Delivery
Improvement

Ask the staff for suggestions, consider all

proposals & implement time saving mechanisms

7-month Timeline
Day 1 1 Month 7 Months Policy

Analyze EHR Charting Policies Assess Changes Hospital Wide

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References

Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from

http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx

Marquis, B.L., & Huston, C.J. (2015b). Leadership roles and management functions in nursing theory and application(8th ed., p.

273). Philadelphia, PA:Wolters Kluwer health/ Lippincott Williams & Wilkins.

Daud-Gallotti, R. M., Costa, S. F., Guimares, T., Padilha, K. G., Inoue, E.N., & Vasconcelos, T.N. (2012). Nursing workload as a

risk factor for healthcare associated infections in ICU: A prospective study. Retrieved from:

https://doi.org/10.1371/journal.pone.0052342

Banner Health. (2017). MyBanner/MyChart Patient Portal. Retrieved from https://www.bannerhealth.com/patients/mybanner-

patient-portal

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