Concept Application Project:

Improving Organizational Culture

Leila Bouanani, Allie Gaither-Banchoff, Leah Skromme, Jesse Smith, and Sarah
Soderberg

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 Overview of Patient Care Delivery System
Tucson Medical-Center - Tucson, AZ
● Medical-Surgical Unit, 34-beds
○ 3 PCTs
○ 1 charge nurse, 1 unit clerk
○ 5-6 RNs
● Low acuity patients
● Focus
○ Lack of recognition/acknowledgement from leadership

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 frontline clinical units. Joint
Commission Journal on Quality Improvement, 28(9), 472-493. 2
 Microsystem Model: Leadership on Med-Surg Unit
● Charge leadership style
○ Transformational: “is committed, has a vision, and is able
to empower others with this vision” (Marquis & Huston,
2017, p. 50)
○ Strong direction at start of shift, then allows individual
staff to take lead. Checks in frequently. Delivers
empowering messages.
● Impact:
○ Strong team-spirit
○ Staff feels supported
○ Inspired to provide best care possible

Marquis, B.L. & Huston C. J. (2017). Leadership roles and management functions in nursing: Theory
and application (9th ed.). Philadelphia, PA: Wolters Kluwer Health.
3
 Microsystem Model: Organizational Culture and Support
● Unit manager/unit ● Impact:
leadership style: ○ Lack of motivation
Authoritarian ○ Low morale
○ Little openness to staff ○ Staff feeling unvalued
input or feedback
○ Lack of on-site direction
○ Lack of positive
feedback
■ Highlights issues
over strengths

Marquis, B.L. & Huston C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed.). Philadelphia, PA: Wolters Kluwer Health.

Perkins, K. M. (2013). “Investigation”... an original leadership concept. Nursing Management, p. 34-39. 4

 Microsystem Model: Patient Focus & Staff Focus

Patient Focus:
● Provide compassion is part of mission statement
● ‘No pass call light’ policy
● Open visiting hours

Staff Focus:
● High patient:RN ratios, but cap at 5-6 patients per nurse
● Staff information boards (not updated)
● Floor orientation is long
● Daisy Awards

Tucson Medical Center [TMC] Healthcare. (2020). Mission, vision, & values. Retrieved from
https://www.tmcaz.com/about-tmc/mission-vision-and-values
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 Microsystem Model: Interdependence of Care Team

● Strong sense of trust among RNs, PCTs, and supervisors

● House supervisor and rapid response nurse run codes
● Strong willingness to help other nurses on unit
○ Efforts to ensure that next shift is equipped and prepared
for success
● Emphasis on teamwork and collaboration

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

http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
6
 Microsystem Model: Use of Information and Healthcare
Technology
● EPIC EHR
● Limited vein finders (1 per 2-3 units)
● Vocera devices for all staff (excluding housekeeping and
security)
● Alarms - bed, call light
○ Several broken call lights
● Facility wide phones for staff
○ Phone lists at nurse’s station - not always comprehensive

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

http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
7
 Microsystem Model:
Process for Healthcare Delivery Improvement
● Mandatory online and simulation trainings
○ Yearly skills simulations
○ Regular online training
● Unit outcomes audited infrequently
● Charge nurse examines quality & safety data each
shift
● House supervisor meeting nightly
● Individual Physician rounding

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

http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
8
Microsystem Model: Staff Performance Patterns

● Quality improvement measures posted for: falls, CAUTIs

and CLABSIs
○ Outdated
● Quarterly unit meetings
○ Discussed complaints
● Charge required to review quality measures daily
● Recurrent performance reviews by the unit manager

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

http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
9
 Specific Aspect Targeted for Improvement
Employee Recognition Initiative
● Charge nurse picks one individual nurse to and one unit
based achievement to recognize during monthly staff
meeting

Organizational support
● Nurses rank recognition as an important part of job
satisfaction, especially recognition from a head nurse
(Lindamood, 2015).
● Verbal feedback is the most meaningful form of
recognition (Lindamood, 2015).
Lindamood M. O. (2015). Commentary on What kind of recognition do staff nurses want? [original article
by Goode C et al appears in AM J NURS 1993;93(5):64-8]. AACN Nursing Scan In Critical Care, 3(6), 8–9.

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Leading the Plan for Healthcare Delivery Improvement
Integrative Principle # 6
● “Integrative nursing focuses on the health and wellbeing of
caregivers as well as those they serve” (Kreitzer, 2015).
● Vocalizing appreciation and awareness for nurses can help
contribute to their overall health and wellbeing
○ This in return can increase nurse job satisfaction,
reduce burnout, and increase patient outcomes

Kreitzer, M. J. (2015). Integrative nursing: Application of principles across clinical settings. Rambam
Maimonides Medical Journal, 6(2), 1-8. doi:10.5041/RMMJ.10200

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Timeline For Implementation

● Disperse
survey #1

Month 1 Month 3 Month 6

● Identify and meet ● Disperse survey

with key stakeholders #2
● Present project to ● Open
staff conversation to
● Implement comments/
intervention on questions during
med-surg unit huddle

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References
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf

Kreitzer, M. J. (2015). Integrative nursing: Application of principles across clinical settings. Rambam
Maimonides Medical Journal, 6(2), 1-8. doi:10.5041/RMMJ.10200

Lindamood M. O. (2015). Commentary on What kind of recognition do staff nurses want? [original article
by Goode C et al appears in AM J NURS 1993;93(5):64-8]. AACN Nursing Scan In Critical Care, 3(6), 8-9.

Marquis, B.L. & Huston C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed.). Philadelphia, PA: Wolters Kluwer Health.

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 frontline clinical units. Joint Commission
Journal on Quality Improvement, 28(9), 472-493.

Perkins, K. M. (2013). “Investigation”... an original leadership concept. Nursing Management, 34-39.

Tucson Medical Center [TMC] Healthcare. (2020). Mission, vision, & values. Retrieved from
https://www.tmcaz.com/about-tmc/mission-vision-and-values

13