Healthcare Delivery System

Quality Improvement Project

Khadija Abdi, Chloe Heenan, Sam Heidersdorf, Lauren Sitler &
Whitney Zito
April 24, 2019

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 Overview of Patient Care Delivery
System
❖ Banner University Medical Center (B-
UMC)

❖ Cardiac Progressive Care Unit (PCU)

❖ Aspect Identified for Improvement:

➢ Staff Focus related to improvement
of low nurse retention rates

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 Microsystem Model: Leadership
❖ “Maintain constancy of purpose, establish clear goals
and expectations, foster positive culture, and advocate
for the microsystem in the larger organization.”
❖ Leadership model: Reflective Thinking & Practice
❖ Supportive Leadership
➢ Charge nurse going into ratio
❖ Ineffective Leadership
➢ Unsupportive to staff needs
➢ Leadership rarely present
➢ Inappropriate staffing

Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H.
(2002). Microsystems in healthcare: Part 1. learning from high-performing front-line clinical units.
The Joint Commission: Journal on Quality Improvement, 28(9), 472-493. 3
 Microsystem Model:
Organizational Culture and Support
❖ “The larger organization provides recognition,
information, and resources to enhance and legitimize the
work of the microsystem.”
➢ Positives:
■ Huddles prior to every shift change
■ Utilization of resources
➢ Negatives:
■ Time management
■ Inappropriate response time

Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., &
Wasson, J. H. (2002). Microsystems in healthcare: Part 1. learning from high-performing
front-line clinical units. The Joint Commission: Journal on Quality Improvement, 28(9),
472-493.
4
 Microsystem Model:
Patient Focus & Staff Focus
❖ Patient Focus
➢ Provide consistent care that is constantly improving in care management, care transformation,
patient experience and innovation including excellent patient care in spiritual and emotional health
by utilizing integrative healing modalities and an array of highly specialized programs and services.
➢ Chaplain, Social worker
➢ Patient survey
➢ Private rooms
❖ Staff Focus “Hiring the right kind of people, integrating the new staff into the culture and work roles, and
aligning daily work roles with training competencies. Continuing education, professional growth and
networking”

Positive
➢ Monthly staff meetings
➢ New Grad Orientation
➢ Career development: once you’re certified, you can take higher acuity patients
Negative
Low retention rate, understaffed
Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., &
Wasson, J. H. (2002). Microsystems in healthcare: Part 1. learning from high-performing
front-line clinical units. The Joint Commission: Journal on Quality Improvement, 28(9),
472-493.
5
 Microsystem Model:
Patient Focus & Staff Focus
❖ Positive
➢ Monthly staff meetings
➢ New Grad Orientation
➢ Career development
■ Certification allows nurse to take on high acuity patients
❖ Negative
➢ Low staff retention
➢ Understaffed

Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in
healthcare: Part 1. learning from high-performing front-line clinical units. The Joint Commission: Journal on Quality
Improvement, 28(9), 472-493.
5
 Microsystem Model:
Interdependence of Care Team
❖ “The interaction of staff is characterized by trust, collaboration,
willingness to help each other, appreciation of complementary
roles, and a recognition that all contributed individually to a
shared purpose.”
❖ Interdependence of Care Team
➢ Care Coordination
➢ Case manager
➢ Social worker
➢ Physician, Nurses, Tech, Respiratory Therapist

Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., &
Wasson, J. H. (2002). Microsystems in healthcare: Part 1. learning from high-performing
front-line clinical units. The Joint Commission: Journal on Quality Improvement, 28(9),
472-493.

6
 Microsystem Model:
Interdependence of Care Team

Positive
➢Teleboxes for cardiac monitoring
➢Unit telephones - often uncharged
Negative
➢No doc box
➢Family and nurses not always included in rounds

Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., &
Wasson, J. H. (2002). Microsystems in healthcare: Part 1. learning from high-performing
front-line clinical units. The Joint Commission: Journal on Quality Improvement, 28(9),
472-493.
8
Microsystem Model: Use of Information
and Healthcare Technology
❖ “Technology smoothes the linkage between information and the
patient care by providing access to the rich information environment.
Can facilitate effective communication, and multiple channels are
used to keep everyone informed at all times and ensure that
everyone is connected”
❖ Information & Healthcare Technology
➢ Computers in hospital rooms
➢ Tele monitors
➢ Call lights, electronic beds, TVs/phones
➢ Tap & Go malfunctions
➢ Pyxis
➢ Cerner electronic health record
➢ Phones
Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002).
Microsystems in healthcare: Part 1. learning from high-performing front-line clinical units. The Joint Commission:
Journal on Quality Improvement, 28(9), 472-493. 7
 Microsystem Model:
Process for Healthcare Delivery Improvement
❖ “...an atmosphere for learning and redesign is supported by the
continuous monitoring of care, use of benchmarking, frequent tests
of change, and a staff that has been empowered to innovate.”
❖ Process Improvement
➢ Chart auditing
➢ ICOUGH (Cough/deep breathe, oral care, understanding,
elevated HOB, incentive spirometer, ambulating)

➢ Benchmarking: Report being given to techs by nurses at shift-

change
➢ Quarterly percentage check of medication scanning (Goal 100%)
Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002).
Microsystems in healthcare: Part 1. learning from high-performing front-line clinical units. The Joint Commission:
Journal on Quality Improvement, 28(9), 472-493.

8
 Microsystem Model:
Staff Performance Patterns
❖ "Performance focuses on patient outcomes, avoidable costs,
streamlining delivery, using data feedback, promoting positive
competition, and frank discussions about performance. Outcomes
are routinely measured, with data feed back into the microsystem,
and changes made based on the data.”
❖ Staff Performance Patterns
➢CAUTI Board
➢Quarterly Performance Reviews
➢Fall Board/Date of Last Fall
➢Daisy Award
➢Kudos board
Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002).
Microsystems in healthcare: Part 1. learning from high-performing front-line clinical units. The Joint Commission:
Journal on Quality Improvement, 28(9), 472-493.
9
 Specific Aspect Targeted for Improvement:
Staff Focus (Nurse Retention)
❖ Increasing Registered Nurse Retention Using Mentors in Critical
Care Services
❖ Why should we introduce a nurse mentorship program?
➢ Newly hired nurses cost thousands of dollars to train (approx. $82-
88,000 per nurse)
➢ New nurses have difficult transition (unsupported, overwhelmed, &
isolated)
Mentorship programs found to improve RN’s sense of belonging and
increase job satisfaction while decreasing stress and anxiety.
❖ Mentorship program used the AMSN program as a guide
❖ As evidence by a 25% higher retention rate in mentored nurses
❖ 91% of nurses with a mentor were retained (continued employment)
Schroyer, C. C., Zellers, R., & Abraham, S. (2016). Increasing registered nurse
retention using mentors in critical care services. The Health Care Manager, 35(3), 251-265. doi:
10.1097/HCM.0000000000000118.

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 Specific Aspect Targeted for Improvement:
Staff Focus (Nurse Retention)
❖ The nurse mentorship program relates to:
➢ The integrative principle #4…
“Integrative nursing is person-centered & relationship-
based”

Kreitzer M. J. (2015). Integrative nursing: application of principles across clinical settings. Rambam
Maimonides medical journal, 6(2), e0016.
doi:10.5041/RMMJ.10200

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 Leading the Plan for Healthcare
Delivery Improvement
❖ Process Improvement
❖ Nurses feeling under supported and overwhelmed
leading to low nurse retention on units
❖ Proposed Intervention: Implement a mentorship program
to provide new graduate RN’s, RN’s returning to the field
and RN’s entering a new specialty for at least the first
year of the position to aid in support, confidence, and
increasing job satisfaction.
➢ AMSN Mentoring Program as a guide

Schroyer, C. C., Zellers, R., & Abraham, S. (2016). Increasing registered nurse retention using mentors in critical care

services. The Health Care Manager, 35(3), 251-265. doi: 10.1097/HCM.0000000000000118.

12
 12-Month Timeline of Events
2019-2020 Month 12+

Implement
Month program
11 hospital wide
Evaluation

Evaluate
Month Unit-Wide
4-10 Program
Implementation

Process
Month change on
Planning 3 unit

Enroll
Month participates/
Diagnosis 2 conduct
mentor
education
Evaluate staff
Month perception/
Assessme 1 Formulate
nt mentorship
development
Steps Root-Cause committee
of Analysis
Implementation

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 References
Banner Health. (2019). Patient Resources. Retrieved from
https://www.bannerhealth.com/patients/patient-resources/patient-care
Institute for Healthcare Improvement. (2019). Clinical microsystem assessment
tool. Retrieved from
http://www.ihi.org/resources/Pages/Tools/ClinicalMicrosystemAssessmentTo
ol.aspx
Kreitzer M. J. (2015). Integrative nursing: application of principles across clinical
settings. Rambam Maimonides medical journal, 6(2), e0016.
doi:10.5041/RMMJ.10200
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management
functions in nursing: Theory and application (8th ed.). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.
Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M.,
Headrick, L.
A., & Wasson, J. H. (2002). Microsystems in healthcare: Part 1. learning
from high-performing front-line clinical units. The Joint Commission: Journal
on Quality Improvement, 28(9), 472-493.
Schroyer, C. C., Zellers, R., & Abraham, S. (2016). Increasing registered nurse
retention using mentors in critical care services. The Health Care Manager,
14
35(3), 251-265. doi: 10.1097/HCM.0000000000000118.
Thank you for your time!
&

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