Healthcare Delivery Systems Improvement Project 2) (5) eT RS ieee CL oR) CNet EAE)Overview of Patient Care Delivery ) so Carondelet St. Joseph’s Hospital so Neurological Intensive Care Unit so Focus: Patient focus related to change in hours of physicians on the unit s Microsystem Assessment (Nelson et al., 2002)Microsystem Model: Leadership s “Balance setting and reaching collective goals, and to empower individual autonomy and accountability, through building knowledge, respectful action, reviewing and reflecting” s» Leadership style: Servant leadership o Put the needs of others, including customers, employees and the community above self so Formal Leaders: Nurse Manager, Nurse Educator, Charge RN so Hands on approach s» Charge RN normally out of ratio (Marquis & Huston, 2017; Nelson et al., 2002) 3Microsystem Mode Organizational Culture and Support SE EE s» Organizational Support o “The larger organization looks for ways to support the work of the microsystem and coordinate the hand-offs between microsystems” o Hospital wide daily interdisciplinary meetings * Overall supportive and helpful s» Rapid Response Teams s Shiftly huddles so Microsystem Culture o Between Nurses o Surgeon - Nurse Disconnect (Nelson et al., 2002) 4Microsystem Model: Patient Focus & Staff Focus ee s Patient Focus: “The primary concern is to meet patient needs - caring, listening, educating, innovating, and establishing a relationship with community.” o Cultural and diversity awareness o Patients involved in plan of care o Interdisciplinary team consulted to provide holistic care s Staff Focus: s) “Selective hiring, integrating new staff into culture and work roles. Expectations of staff are high regarding jperionnanieg) continuing education, professional growth, and networking.” o Education manager and best practice research o Approachable and open nurse manager and physicians o Appreciation for high achieving staff members Nelson et al., 2002, p. 485) 5 3Microsystem Model: Interdependence of Care Team SE EE so The interaction of staff is characterized by trust, collaboration, willingness to help each other, appreciation of complementary roles, and a recognition that all contribute individually to a shared purpose.” ® Daily interdisciplinary meetings with doctors, nurses, social workers, nutrition, and case manager. s» Facilitates communication, understanding, and streamlined plan of care that is focused on the patient. (Nelson et al., 2002, p. 485)Microsystem Model: Use of Information and Healthcare Technology so “Technology has dramatically changed how nurses communicate and perform their work” s» Vocera for charge nurse so Electroencephalogram (EEG) monitoring system s Portable computers (Wireless Local Area Networking) s» Electronic Health Record (EHR) s» Online access to education material (Marquis & Huston, 2017, p. 506)Microsystem Model: Process for Healthcare Delivery Improvement s» “Measuring performance is impossible if standards have not been clearly established” so Benchmarking to other units for improved patient outcomes so Best practice programs to ensure quality patient care so» Feedback from: o Patient o Staff so Unit statistics comparison so Outcome audits (Marquis & Huston, 2017, p. 614)Microsystem Model: Staff Performance Patterns “_.an appraisal of how well employees perform the duties of their job as delineated by the job description or some other prespecified criteria.” Performance appraisals o An important part of continuous quality improvement is “the empowerment of employees by providing positive feedback and reinforcing attitudes and behaviors that support quality and productivity”. Employees know the level of their job performance o Make organization’s expectations known o Influences the employer’s decisions about promotions, salary increases, unit transfers, disciplinary actions, and terminations Motivates employees Patient outcome statistics (Marquis & Huston, 2017, p. 622 and 647) 2)cific Aspect Targeted for Improvement SS x Late morning multidisciplinary rounds o Start at 10:30am o Physicians are not seeing patients and patients’ families until 11:00/11:30am o Doctor orders are not in the computer until 11:30/noon, leading to delayed patient careSpecific Aspect Targeted for Improvement (cont.) SS s» Patient focus so Proposed change: morning interdisciplinary rounds at 0830 instead of 1030 o Have the unit’s physicians work 0700 to 1900 instead of 0900 to 2100 o Allow for quicker and more efficient attention to patient needs o Allow for earlier downgrades — less costs and less stress for patients and patient familiesLeading the Plan for Healthcare Delivery Improvement Presentation of research to hospital staff o Provide evidence regarding the importance of early rounding on patient outcomes and satisfaction Empirical-rational method: o Assumes people are rational and interested in positive changes and will make those changes if information is provided that suggests the change makes sense Create schedule changes and allow for adjustment period Collect feedback surveys from doctors/patients on their perception of the change and track improvements in patient outcomes through audits (Marquis & Huston, 2017) 12Timeline of Events 5 months 2 months Evaluation 1 month I Time to Weeks 2-3 [re adjust to Week 1 4 Present change | Gather proposal evidence Assess resistance to changeReferences Li, J., Talari, P., Kelly, A., Latham, B., Dotson, S., Manning, K., Williams, M. V. (2018). Interprofessional Teamwork Innovation Model (ITIM) to promote communication and patient-centred, coordinated care. BMJ Quality & Safety. doi:10.1136/bmjqs-2017-007369 Marquis, B. L., & Huston, C. J. (2017). Leadership role and management functions in nursing: Theory and application (9th ed.). Philadelphia: Wolters Kluwer Health. Nelson, U. C., Bataleden, 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. Journal On Quality Improvement, 28 (9), 472-493. doi:10.1016/S1070- 3241(02)28051-7 14