Healthcare Delivery Systems

Improvement Project

Remy Goc, Natasha Lindblom, Jonathan Martens, Paige Martin

19 April 2017

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Overview of Patient Care Delivery System

Southern Arizona Veterans Affairs Health Care System

2 South - Orthopedics/Medical Surgical Floor

Focus: Patient-Centered Care

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Microsystem Model:
Leadership

Democratic leadership, appropriate for groups who

work together for extended periods, promotes
autonomy and growth in individual workers
Emphasis is on collaboration
Suggestions and guidance valued
Less Control

Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application
(8th ed., pp. 40). Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins.
3
Microsystem Model:
Organizational Culture and Support

Shared values, attitudes, and beliefs reflect the

clinical mission and support a collaborative and
trusting environment
Veterans respected by nurses - high level of patriotism
Teamwork encouraged and practiced
Support from management limited and variable
Time limitations detracted from quality improvements

Marquis, B.L., & Huston, C.J. (2015c). Leadership roles and management functions in nursing theory and application
(8th ed., pp. 274-276). Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins.
Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002,
September 2002). Microsystems in health care: Part 1. earning from high-performing front-line clinical units.
Journal on Quality Improvement, 485. Retrieved from
http://lsatqdm.qdmnet.com/qdm/microsystems/JQIPart1.pdf 4
Microsystem Model:
Patient Focus & Staff Focus

Patient Focus
We are all here for the same reason -the patient
Patient-Centered Care - Nurses, Patient Care Technicians
Staff Focus
High expectations
Daily work roles not matched to skill level
Unit Specific Changes - Training not provided at sufficient
detail.

Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application
(8th ed., pp. 327). Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins.
Nelson, E. C., Batalden, 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, 485. Retrieved from http://lsatqdm.qdmnet.com/qdm/microsystems/JQIPart1.pdf
5
Microsystem Model:
Interdependence of Care Team
Team-based models of primary health-care teams
have been created to achieve better coordination of
care, increased focus on collaborative problem solving
and decision making, and a commitment to patient-
centered care
Med-Surg team provides effective interdisciplinary
teamwork
Specialty areas with own priorities conflicted with
medical-surgical team priorities resulting in
miscommunication and delay of patient care

Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and
application (8th ed., p. 321). Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins.
6
Microsystem Model:
Use of Information and Healthcare Technology

The use of hospital information system configurations

increases the likelihood that staff will be able to find
resources when they need them and that they are as
up to date as possible
Available technology decreases time spent on
administrative activities thereby increasing time for
patient focus (variable).
Patients can easily access their medical record at
https://www.myhealth.va.gov/mhv-portal-
web/download-your-own-va-medical-records

Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and
application (8th ed., pp. 452-454). Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins.
7
Microsystem Model:
Process for Healthcare Delivery Improvement

Quality improvement consists of systematic and

continuous actions that lead to measurable
improvement in health care services and the health
status of targeted patient group.
Improvement projects (tasks) implemented
Patient antibiotic education
Additional catheter care charting and protocol (per Joint
Commission); doctor compliance
Pharmacy would have patients medications ready for each
day and time; individualized

Health Resources and Services Administration (2017). Quality improvement. Retrieved from
https://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/
The Joint Commission (2017). National Patient Safety Goals Effective January 2017. Retrieved from
https://www.jointcommission.org/assets/1/6/NPSG_Chapter_HAP_Jan2017.pdf 8
Microsystem Model:
Staff Performance Patterns

Performance patterns reviewed by nurse

managers/leadership
Improvement efforts related to evidence-based
practice and review
Medical staff aware of needed adjustments based
upon posted performance pattern outcomes

The Commonwealth Fund (2017). Health Care Delivery System Reform. Retrieved from
http://www.commonwealthfund.org/grants-and-fellowships/programs/health-care-delivery-system-reform
9
Specific Aspect Targeted for Improvement

Staff based on patient acuity and nurses level of

experience (use patient acuity surveys)
Nursing workloads directly impact nurses ability to
deliver superior patient care
Goal: Improve patient focus by establishing patient
ratios based on acuity level and nurse experience
Significant findings showed:
Nurses reported satisfaction with equity of patient
assignments from 7% before tool rollout to 55% after
80% of nurses reported the tool was not a waste of time

Carayon P, Gurses AP. Nursing Workload and Patient SafetyA Human Factors Engineering Perspective. In: Hughes
RG, editor.
Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research
and Quality (US); 2008 Apr. Chapter 30. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK2657/
Kidd, M., Grove, K., Kaiser, M., Swoboda, B., & Taylor, A. (2014) A new patient-acuity tool promotes
nurse-patient assignments. American Nurse Today, 9(3), 1-4.
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Leading the Plan for Healthcare Delivery
Improvement

National Safe Patient Ratio Bill

Literature: Establishing adequate minimum direct care
registered nurse-to-patient ratios that take into account
patient acuity measures will improve the delivery of
quality health care services and guarantee patient
safety
One year timeline
Morale & Education Unit-Implementation Analysis
1-3mo 4-11mo 12 mo
Kidd, M., Grove, K., Kaiser, M., Swoboda, B., & Taylor, A. (2014) A new patient-acuity tool promotes
nurse-patient assignments. American Nurse Today, 9(3), 1-4.
Schakowsky, J. (2015). HR 1602 Nurse staffing standards for patient safety and quality care act of 2015. Retrieved
from: https://www.congress.gov/bill/114th-congress/house-bill/1602/text
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References

Carayon P, Gurses AP. Nursing Workload and Patient SafetyA Human Factors Engineering

Perspective. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook

for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr.

Chapter 30. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2657/

Health Resources and Services Administration (2017). Quality improvement. Retrieved from

htps://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/

Kidd, M., Grove, K., Kaiser, M., Swoboda, B., & Taylor, A. (2014) A new patient-acuity tool promotes

nurse-patient assignments. American Nurse Today, 9(3), 1-4.

Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory

and application (8th ed., pp. 8, pp. 40-41, pp. 260-286, pp. 366, pp. 452-456, pp. 547).

Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

12
References

Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J.

H. (2002, September 2002). Microsystems in health care: Part 1. learning from high-performing

front-line clinical units. Journal on Quality Improvement, 485. Retrieved from

http://lsatqdm.qdmnet.com/qdm/microsystems/JQIPart1.pdf

Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for

Healthcare Research and Quality (US); 2008 Apr. Chapter 30. Retrieved from:

https://www.ncbi.nlm.nih.gov/books/NBK2657/

Schakowsky, J. (2015). HR 1602 Nurse staffing standards for patient safety and quality care act of

2015. Retrieved from: https://www.congress.gov/bill/114th-congress/house-bill/1602/text

The Commonwealth Fund (2017). Health Care Delivery System Reform. Retrieved from

http://www.commonwealthfund.org/grants-and-fellowships/programs/health-care-delivery-

system-reform
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References

The Joint Commission (2017). National Patient Safety Goals Effective January 2017. Retrieved from

https://www.jointcommission.org/assets/1/6/NPSG_Chapter_HAP_Jan2017.pdf

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