Quality Improvement Project

By: Riley Ford, Grace Cleary, Julia Suerth, Jamie Wientjes

and Sanisa Mendoza
 Overview of Patient Care Delivery System
● Southern Arizona Veterans Affairs (VA) Hospital
○ 2 South: Post-Operative Floor
● Focus:
○ Implement a preceptor training program within the
hospital to ensure students and new hires receive
adequate education
 Leadership
● Laissez-faire Leadership Style
○ “Disperses decision-making throughout the group”

VA 2S: Post-Operative Floor

○ Charge Nurse chosen at random beginning of each shift
○ Charge nurse in rotation
○ Biggest charge duty: admission and discharges
○ Unit Manager has office on the floor but is only available
Monday- Friday 7am - 5pm
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 47).
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Organizational Culture and Support
“Organizational culture is the total of an organization’s values,
language, traditions, customs.”

2S: Post-Operative Floor

● Friday celebration of Veterans- Wear red to “Remember everyone deployed”
● Respect for Veterans/military families
● New employee training on Veterans and background of military
● Highly regarded patriotism
● Microsystem Culture
○ Nurses → Nurses
○ Nurses → Doctors
○ Quality over ego
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.
 Patient Focus and Staff Focus
Patient Focus: “The primary concern is to meet all patient needs- caring, listening,
educating, and responding to special requests, innovating to meet patient needs, and
smooth service flow.”

○ Healing
○ Interdisciplinary teams
○ Receiving safe care
○ Patients receive all resources needed prior to discharge

Staff Focus: “Selective hiring, integrating new staff into culture and work roles,
high expectations regarding performance, education, growth, and networking.”

○ Respecting our Veterans!

○ Evidenced Based Care
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
○ Incentives for loyal nurses http://clinicalmicrosystem.org/uploads/documents/microsystem_ assessment.pdf
 Interdependence of Care Team
“The interaction of staff is characterized by trust, collaboration,
willingness to help each other, appreciated of complementary roles,
respect and recognition that all contribute individually to a shared
purpose.”

2S Post Operative Floor:

● Interdisciplinary team rounding Monday-Friday
● Teaching hospital
● Communication is done via pager and phone
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_ assessment.pdf
 Use of Information and Healthcare Technology
2S Post Operative Floor:
● Computerized Patient Record System (CPRS)/ Vista
○ Allows for transfer of care
○ In person training
○ Outdated and inefficient charting system
● WOW/Mobile Charting Carts
○ Medication administration and charting made more efficient
● Phones/Pager
○ Allows for more private communication
○ Lack of adequate amount on each unit (Marquis & Huston, p. 506, 2017
● Access to most updated healthcare technology
 Process for Healthcare Delivery Improvement
Activities
“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.”
2S Post Operative Floor:
● Working progress notes to be updated every hour by assigned RN
● Template matching
● QUERI - Quality Enhancement Research Initiative
● Incentive for increasing level of education and certifications
● “Mock codes” every couple of months with interactive mannequins, paid for this
activity
● Learning modules open for enrollmentJohnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_ assessment.pdf
 Staff Performance Patterns
“The employee must know in advance what happens if the expected performance
standards are not met. The employee needs to know how information will be
obtained to determine performance.”

2S: Post-Operative Floor:

● Measuring days without falls, CAUTIs & incidents (medication errors)

● VANOD: skin assessment
● Morning huddle
● Dual RN check off for insulin & high risk medications
● Every new patient: 4 eyes skin assessment
● Employee of the Month/Daisy Award Marquis, B. L., & Huston, C. J. (2017). Leadership roles
and management functions in nursing: Theory and
● Nurse Manager verifies charting application (9th ed. p. 649). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.
 Specific Aspect Targeted for Improvement
● Goal: all preceptors of nursing students, new graduates, and new hires should
be trained
● Rationale:
○ Currently the VA lacks a preceptor education program
■ There is no incentive for nurses to be preceptors
■ VA is not CCNE accredited
○ Preceptor courses have multiple hospital benefits
■ reduce turnover and associated costs, promote consistent and safe practices,
increase new nurse job satisfaction and competency
■ Trained preceptor → help ensure safe & competent patient care
● Proposed change:
○ 3 day, 12 hour course
○ Implement required educator education to the preceptor on how to orient
students and new hires to the assigned unit McKinney, S. & Aguilar, M. (2020). Implementing a comprehensive preceptor
development program through professional governance. Journal for Nurses in
Professional Development, 36 (2), 111-113.
https://doi.org/10.1097/NND.0000000000000613
 Integrative Nursing Principle
Undoubtedly, nurses work in
intense, high-stress environments
and are vulnerable to symptoms of
anxiety and burnout that impacts
their own health and wellbeing, as
well as the care of patients. Self-
awareness and self-care are core
practices that are foundational to
integrative nursing.
Kreitzer M. J. (2015). Integrative nursing: application of principles across clinical settings. Rambam Maimonides medical journal, 6

(2), e0016. doi: 10.5041/RMMJ.10200

 Leading the Plan for Healthcare Delivery
Improvement
● Goal: 50% of unit nurses will be adequately trained to precept students, new
graduates and new hire RN’s within the first year
○ Objective 1: Preceptors will complete a program that consists of 12 hours
of training over 3 days in which they are taught effective interpersonal
skills and clinical competence
○ Objective 2: Preceptors will be assessed of their knowledge through in
class competency activities
○ Objective 3: Administration will give financial incentive to encourage
nurses to complete this program
 Project Timeline
3 Months 1 Year 2 Years

Training Add-
Planning Trial Run Training Evaluation on/changes

6 Months 1.5 Years 2.5 Years

Questions?
 References
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from

http://clinicalmicrosystem.org/uploads/documents/microsystem_ assessment.pdf

LaCroix, D. (2019). Leadership and management. [Powerpoint Slides]. Retrieved

from www.d2l.arizona.edu

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. (2017). Leadership roles and management functions

in nursing: Theory and application (9th ed). Philadelphia: Wolters Kluwer

Health/Lippincott Williams & Wilkins.

McKinney, S. & Aguilar, M. (2020). Implementing a comprehensive preceptor development program through professional

governance. Journal for Nurses in Professional Development, 36 (2), 111-113. Doi: