Healthcare Delivery Systems

Improvement Project

Antonio Solis, Douglas Turner, Duyen Pham, Janet Diaz, and Ruthlyn Kelly
Date: 11/16/2016

Overview of Patient Care Delivery System

Carondelet Saint Josephs Hospital

Adult Medical/Surgical (5 East)

Microsystem Model:
Leadership

I feel like the Charge Nurse listens to my concerns

and really tries to help me fix my problems by
finding alternative solutions.

Our Nurse Manager is really approachable and

attentive to patient needs.
o Democratic Leadership
o Decentralized
o Nurses felt valued
Frandsen, B. (2013). Nursing Leadership Management & Leadership Styles. American Association of Nurse
Assessment Coordination. Retrieved from https://www.aanac.org/docs/white-papers/2013-nursing3
leadership---management-leadership-styles.pdf?sfvrsn=4.

Microsystem Mode
Organizational Culture and Support

I feel valued, but could use more support with

staffing and workload.

Culture/Support
o Recognition- You Wowed Me/I Love My PCT
o Nurse/Patient ratio 1:6
o Inconsistent Supplies/Resources
o Inconsistent Communication
o Communication essential for effective clinical
groups

Wasson, Godfrey, Nelson, Mohr, & Batalden, (2003). Joint Commission Journal on Quality and Safety. Microsystems in
Health Care: Part 4. Planning Patient-Centered Care, 29(5), 227-237.
4

Microsystem Model:
Patient Focus & Staff Focus

Patient Focus
o Patient Centered Care
o Shared Decision Making
Staff Focus
o New Graduates & New Hires receive orientation and
training for 6-8 weeks
o New Hires care for a maximum of 4 patients for
4-6 months
o Continuous education is mandatory

Institute for Healthcare Improvement, (2016). Introduction to Patient-Centered Care. Retrieved from:
http://app.ihi.org/lmsspa/#/6cb1c614-884b-43ef-9abd-d90849f183d4/8eb52137-21d7-4b30-afcd-fd781de6d6d5
Wasson, Godfrey, Nelson, Mohr, & Batalden, (2003). Joint Commission Journal on Quality and Safety. Microsystems in
Health Care: Part 4. Planning Patient-Centered Care, 29(5), 227-237.
5

Microsystem Model:
Interdependence of Care Team

A unit with a truly collaborative team will have a

strong work culture and a healthy work
environment as a result.
o Team collaboration
o Communication
o Trust and Respect

Blake, N. (2013). Collaboration: A key component of excellence.AACNAdvancedCriticalCare,24(1), 30-32.

doi:10.1097/NCI.0b013e31827b7848 [doi]

Microsystem Model:
Use of Information and Healthcare Technology

The Cerner electronic medical record (EMR) is an

integrated database that allows healthcare professionals
to electronically store, capture and access patient health
information in the acute setting.
VOCERA provides mobile communication solutions for
hospital staff.
BCMA (Bar Code Medication Administration) Proper use
of BCMA system can reduce the incidence of medical
error.

Cerner.(2016). AcuteCareElectronicMedicalRecord.Retrievedfrom
http://www.cerner.com/solutions/hospitals_and_health_systems/acute_care_emr/
Vocera.(2016). TheVoceraBadge.Retrievefrom https://www.vocera.com/microsite/badge?
utm_source=google&utm_medium=cpc&utm_content=vocera%2520badge&utm_campaign=Branded%2520Products
%2520-%2520VCS&utm_term=vocera%2520badge&gclid=CPSwjuDcpNACFUuRfgodpvsPDg
Marini, S. D., & Hasman, A. (2009). Impact of BCMA on medication errors and patient safety: A summary.Studiesin
HealthTechnologyandInformatics,146, 439-444.
7

Microsystem Model:
Process for Healthcare Delivery Improvement

An atmosphere that promotes learning and

monitoring of care is implemented on the unit to
empower staff and help improve the delivery of
care.

Activities/Process
o Bulletins/Posters on unit
o Optional in-services
o Benchmarking
o Error and Incident report system

U. S. Department of Health and Human Services Health Resources and Services Administration. (2011).
Quality improvement. Retrieved from
8
http://www.hrsa.gov/quality/toolbox/508pdfs/qualityimprovement.pdf

Microsystem Model:
Staff Performance Patterns

Data is collected across the unit to provide

feedback about patient outcomes, satisfaction, and
safety to increase staff awareness of performance
and results.

Data Collected on:

o Patient satisfaction (736 surveys Jan-Sept 2016)
o Hospital Acquired Infections
o Falls

Waters, T. M., Daniels, M. J., Bazzoli, G. J., Perencevich, E., Dunton, N., Staggs, V. S., ... & Shorr, R. I.
(2015). Effect of Medicares nonpayment for hospital-acquired conditions: lessons for9future
policy. Journal of American Medical Association internal medicine, 175(3), 347-354 .

Specific Aspect Targeted for Improvement

Target: Performance patterns/results

o Low patient satisfaction results
Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) survey.
Goal: Increase patient satisfaction (aeb patient
satisfaction surveys).

Kutney-Lee, A., McHugh, M. D., Sloane, D. M., Cimiotti, J. P., Flynn, L., Neff, D. F., & Aiken, L. H. (2009).
Nursing: a key to patient satisfaction. HealthAffairs, 28(4), 669-677.
10

Specific Aspect Targeted for Improvement

(cont.)

Quantitative and qualitative studies found

patients top concerns:
o Feeling respect
o Good communication among staff
o Clear and simple explanations
o Happy employees

Scott, J. E., & Baden, H. P. (2015). Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic
Way. CriticalCareMedicine, 43(9), e403.
Accreditation Association for Ambulatory Health Care. (2015). The importance of patient satisfaction. Retrieved from
https://www.aaahc.org/Global/pdfs/Connection/2015%20May%20Connection_The%20Importance%20of%20Patient
%20Satisfaction.pdf
11

Leading the Plan for Healthcare Delivery

Improvement

1-2
months

Data
Collection

3-4
months

Information
Sessions

5-8
months

Staff
Training

6-12
months

13-14
months

Evaluation

Employee
Appreciation

Wolosin, R., Ayala, L., & Fulton, B. R. (2012). Nursing care, inpatient satisfaction, and value-based purchasing: vital
connections. JournalofNursingAdministration, 42(6), 321-325.
Lowe, G. (2012). How employee engagement matters for hospital performance. Healthcare Quarterly, 15(2), 29-39.
O'Leary, K. J., Darling, T. A., Rauworth, J., & Williams, M. V. (2013). Impact of hospitalist communication skills training
on patientsatisfaction scores. Journal of hospital medicine, 8(6), 315-320.
12

References

Blake, N. (2013). Collaboration: A key component of excellence.AACNAdvanced

CriticalCare,24(1), 30-32. doi:10.1097/NCI.0b013e31827b7848 [doi]
Cerner.(2016). AcuteCareElectronicMedicalRecord.Retrievedfrom
http://www.cerner.com/solutions/hospitals_and_health_systems/acute_care_emr/
Frandsen, B. (2013). Nursing Leadership Management & Leadership Styles.
AmericanAssociationofNurseAssessmentCoordination. Retrieved from
https://www.aanac.org/docs/white-papers/2013-nursing-leadership--management-leadership-styles.pdf?sfvrsn=4.
Institute for Healthcare Improvement, (2016). Introduction to Patient-Centered
Care. Retrieved from: http://app.ihi.org/lmsspa/#/6cb1c614-884b-43ef-9abdd90849f183d4/8eb52137-21d7-4b30-afcd-fd781de6d6d5
Lowe, G. (2012). How employee engagement matters for hospital performance.
Healthcare Quarterly, 15(2), 29-39.
Marini, S. D., & Hasman, A. (2009). Impact of BCMA on medication errors and
patient safety: A summary.StudiesinHealthTechnologyandInformatics,146,
439-444.
O'Leary, K. J., Darling, T. A., Rauworth, J., & Williams, M. V. (2013). Impact of
hospitalist communicationskills training on patient satisfaction13
scores. Journal of
hospital medicine, 8(6), 315-320.

References

U. S. Department of Health and Human Services Health Resources and Services

Administration. (2011). Qualityimprovement. Retrieved from
http://www.hrsa.gov/quality/toolbox/508pdfs/qualityimprovement.pdf
Vocera.(2016). TheVoceraBadge.Retrievedfrom
https://www.vocera.com/microsite/badge?
utm_source=google&utm_medium=cpc&utm_content=vocera
%2520badge&utm_campaign=Branded%2520Products%2520%2520VCS&utm_term=vocera%2520badge&gclid=CPSwjuDcpNACFUuRfgodpvsPDg
Wasson, Godfrey, Nelson, Mohr, & Batalden, (2003). Joint Commission Journal on Quality
and Safety. MicrosystemsinHealthCare:Part4.PlanningPatient-CenteredCare, 29(5),
227-237.
Waters, T. M., Daniels, M. J., Bazzoli, G. J., Perencevich, E., Dunton, N., Staggs, V. S., ...
& Shorr, R. I. (2015). Effect of Medicares nonpayment for hospital-acquired conditions:
lessons for future policy. JournalofAmericanMedicalAssociationinternal
medicine, 175(3), 347-354.
Wolosin, R., Ayala, L., & Fulton, B. R. (2012). Nursing care, inpatient satisfaction, and
value-based purchasing: vital connections. JournalofNursingAdministration, 42(6), 321325.

14