Healthcare Delivery Systems

Improvement Project
Patient Focus
❧ ❧
Connie Tran, Yessenia Rodriguez, Jessica Oh, Samantha Merchant, Rebecca Shiao
April 25, 2018

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Overview of Patient Care Delivery System

❧ Tucson Medical Center

❧ Unit 600 Cardiac Care
❧ Focus: Patient focus related to dissatisfaction
and interruption of smooth service flow due to
patients not being properly oriented to the
hospital

2
All medical programs. (n.d.) Retrieved from http://www.tmcaz.com/cardiac-care
Microsystem Model:
Leadership

❧ “Leaders are in the front, moving forward, taking

risks, and challenging the status quo.”
❧ Presence of leaders:
o Charge Nurse
o Unit Manager
❧ Leadership activities:
o white boards
o audits
o communication

Marquis, B. L. & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory
and application (9th ed. p. 40). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 3
Microsystem Model
Organizational Culture and Support

❧ “The values and behaviors that contribute to the unique

social and psychological environment of an organization”
❧ Recognition Awards:
o Daisy Award
o Nurse Anniversary
o Employee of the Quarter
❧ Education/ Resources
o Free ACLS/ BLS
o PCTs to Nursing Track
o Information Services

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/Lippincott Williams & Wilkins. 4
Microsystem Model:
Patient Focus & Staff Focus

❧ Patient Focus
o “It humanizes, personalizes, and demystifies the
patient experience.”
o Orientation to the unit
o Consistent communication
❧ Staff Focus
o “Many staff development activities are generated to
ensure that workers at each level are competent to
perform the duties assigned to the position.”
o 60 and 90 day evaluations
o Nurse to patient ratios
Marquis, B.L. & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory
and application (9th ed. p. 364, 416). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins. 5
 Microsystem Model:
Interdependence of Care Team

❧ Interdependence of the care team occurs through “team

building and providing a continual supportive learning
environment” which the workplace becoming “more productive
due to team compatibility”.
❧ Trust and collaboration
o Answering call lights
o Showing appreciation
❧ Communication through vocera
❧ Areas for Improvement:
o Increased tech responsibilities
o No current interdisciplinary rounding
Marquis, B. L. & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. p. 554). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 6
Microsystem Model:
Use of Information and Healthcare Technology

❧ “Some organizations have created internal

electronic data… such as policy and procedure
manuals… this increases the likelihood that staff
will be able to find such resources...they are up-
to-date as possible.”
❧ Online charting (EPIC) and reference manuals
❧ Vitals automatically transfer to patient’s chart
❧ Charge nurse’s phone
❧ Efficient use of Voceras

Marquis, B. L. & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory
and application (9th ed. p. 364, 416). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins. 7
Microsystem Model:
Process for Healthcare Delivery Improvement

❧ “Continuous quality improvement was a process

developed...to [identify] doing the right actions the right
way, the first time, and... using reactive problem solving
that leads to quality outcomes.”

❧ Computer & in-person training

❧ Binders with information for staff
❧ Unit meetings
❧ Unit-based council

Marquis, B. L. & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory
and application (9th ed. p. 554). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins
8
Microsystem Model:
Staff Performance Patterns

❧ “Performance appraisals let employees know the level of

their job performance as well as any expectations that
the organization may have of them.”

❧ Performance Assessments
o 30 Day Performance Appraisal
o Fall Risk Assessment Audits

❧ Feedback
o Report to Charge Nurse
o Monthly Staff Meetings
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/Lippincott Williams & Wilkins. 9
Specific Aspect Targeted for Improvement:
Patient Focus

❧ Patients often come to the unit and are not informed

about unit procedures and regulations, such as
frequency of vital signs, I/Os, and diet orders.
❧ Nurse/PCT sometimes forgets to inform the patient
because of workflow and interruptions.
❧ Proposed interventions: create a checklist for staff to
use when admitting patients
❧ Checklist Points
o Diet orders
o Intake/Output
o Frequency of Vital Signs
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 Leading the Plan for Healthcare Delivery
Improvement

❧ Provide data regarding checklist benefits and current items that

are being missed by staff and patient satisfaction scores
(rational-empirical)
❧ “Humans are rational humans who will change when given
factual information documenting the need for change.”
❧ Incorporate leaders into staff education/checklist development
program.
❧ Education provided to staff on policy change during shift huddle
and monthly meeting
❧ Process improvement evaluation and implementation hospital
wide.
Soong, C., Daub, S., Lee, J., Majewski, C., Musing, E., Nord, P... Bell C. M. (2013). Checklist of Safe Discharge
Practices. J. Hosp. Med, 8, 444-449. doi:10.1002/jhm.2032
Marquis, B. L. & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. p. 193). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 11
 Timeline of Events

>6 months
5-6 months
4-5 months TMC
Evaluate Wide
2-3 months Unit-Wide
1 month Enact System
Develop change
checklist on 600
Root-
according Cardiac
Cause
to Care
analysis
unit
for patient evidence
satisfaction based
scores guidelines
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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.
❧ Soong, C., Daub, S., Lee, J., Majewski, C., Musing,
E., Nord, P... Bell, C. M. (2013). Checklist of Safe
Discharge Practices. J. Hosp. Med, 8, 444-449.
doi:10.1002/jhm.2032

13