Improving Communication Between the

Interdisciplinary Healthcare Teams

Ali Caballero, Nic Lettera, Michael Malarayap, Jennie Miller, Sydney Mobley
April 28, 2021
 Overview of Patient Care Delivery System

Oro Valley Hospital

● CVICU, 18 bed, single patient rooms.
○ The CVICU team consists of staff nurses, hospitalists,
and varying specialty physicians based on the needs of
the patient.
● Focus
○ Impaired interdependence of the healthcare team related
to role confusion and inconsistent communication due to
a lack of prioritization and promptness of entering orders,
as well as reliance on verbal orders by physicians.
 Microsystem Model:
Leadership
CVICU Leadership
● Charge nurse leads in a democratic style
○ “Less control is maintained, others are directed
through suggestions and guidance, constructive
criticism, decision making involves others, emphasis
on “we.”
● Encourages autonomy while also promoting collaboration
● Unit manager also appropriately provides support to unit
RNs

Marquis, B. L. & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed).
Philadelphia, PA: Wolters Kluwer Health.
 Microsystem Mode:
Organizational Culture and Support
Unit Management
● Unit manager also practices democratic leadership
● Huddle before oncoming shift with unit manager, charge
nurse, and unit RNs to review patients’ acuity and
healthcare needs
○ Recommendations for improvement of quality
measures also addressed
● Bed meetings with the charge RNs from other units
within the hospital
Marquis, B. L. & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed).
Philadelphia, PA: Wolters Kluwer Health.
 Microsystem Model:
Patient Focus & Staff Focus
Culture and Work Roles Listening and Caring
● 2 rotating house supervisors ● RNs organize and delegate
● Nurse patient ratio 1:2 patient care
● ICU director does new hires for ● Patient and family
unit education on plan of care,
● 3 month program for new grads medications, and lines
with 2 or more preceptors ● Focused bedside report
● Unit offers tuition reimbursement ● Clustered care and low
and salary bonuses for stimulation environment to
continuing education promote patient rest
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from http://clinicalmicrosystem.org/uploads/documents/microsystem_
assessment.pdf
 Microsystem Model:
Interdependence of Care Team
Trust, Collaboration, and Shared Purpose
● Charge nurse and physicians run codes and delegate
tasks to unit RNs
● Emphasis on collaboration of interdisciplinary team
○ RTs, PICC team, dialysis nurses, hospitalists,
specialists (cardiologist, neurologist, etc.)
● Healthy team environment
○ RNs helped each other with tasks
○ Trusting relationship between RNs and charge nurse
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from http://clinicalmicrosystem.org/uploads/documents/microsystem_
assessment.pdf
 Microsystem Model:
Use of Information and Healthcare Technology
Integration of Information
● EMR: Cerner
● Omnicell - medication dispensing system
● Each nurse had their own computer
○ PCTs shared computers
○ Timely IT support
● Single unit-wide phone
○ Sheet at nurse’s station with numbers and extensions
● Patients can access own health records
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from http://clinicalmicrosystem.org/uploads/documents/microsystem_
assessment.pdf
 Microsystem Model:
Process for Healthcare Delivery Improvement

Process Improvement
● Care bundle deadlines.
● Incentives for continuing education.
o Tuition reimbursement.
o Bonuses for certifications.
● Charge nurse hold bed meetings at 1600 everyday.
● Unit based council meetings held monthly for staff to
voice their concerns for improvement.

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

assessment.pdf
 Microsystem Model:
Staff Performance Patterns
Performance Results
● Benchmarks are reviewed and/or informed through
email and staff meetings.
● Audits are conducted for performance improvement.
● Annual performance review for all employees.
o Community Health System performance evaluation
tool and unit based competency form.
● Monthly performance meetings.

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

assessment.pdf
 Specific Aspect Targeted for Improvement

Lack of Congruency Between Verbal and Entered Orders

● Impaired Interdependence of the healthcare team related
to role confusion and inconsistent communication due to a
lack of prioritization and promptness of entering orders, as
well as reliance on verbal orders by physicians.
○ Educational sessions and reflective logging overseen
by the formation of a QIP Committee.
● Improved quality and timeliness of communication allows
for an increase in team interdependence.
 Integrative Nursing Principle

Integrative nursing principle #4:

● “Integrative nursing is person centered and relationship
based.”
● Educational sessions and logging to assess application
of intervention.

Kreitzer, M. J. (2015). Integrative nursing: Application of principles across clinical settings. Rambam Maimonides Medical Journal,
6(2). doi:10.5041/RMMJ.10200
 Leading the Plan for Healthcare Delivery
Improvement
Weeks
0-2 2-3 4 5-10 10+

Education Administer Begin Data Application

planning 5 30-minute implement - collection/ hospital
and education ation of evaluation wide
formation of sessions. orders and of
QIP logs. outcomes
committee
 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). 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, PA: Wolters Kluwer Health.