Healthcare Delivery Systems

Improvement Project: Patient

Focus/Staff Focus
Claire Decraene, Shianne Evans, Nicole Jarman,
Haley Kennedy & Quinn Pond
 Overview of Patient Care Delivery
System
● Northwest Medical Center (NWMC)
● Unit: Cardiovascular Intensive Care Unit (CVICU)
● 15 beds
● Focus: Improve communication between patients and
healthcare professionals to increase quality of care.
 Microsystem Model: Leadership
● Leaders are “out front, taking risks, attempting to achieve
shared goals, and inspire others to action”
● Democratic
○ Constructive criticism
○ “We”, teamwork
● Role of the charge nurse and leaders on NWMC CVICU
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed., pp. 40).
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Perez, L. (2019). Leadership & management & decision making [PowerPoint slides]. Retrieved from
https://d2l.arizona.edu/d2l/le/content/787890/viewContent/7276442/View
 Microsystem Model: Organizational
Culture and Support
● “An organization’s expectations, experiences, philosophy, and
values that hold it together and is expressed in its self-image,
inner workings, interactions with the outside world, and future
expectations”
● Huddles every shift
● Acuity sheet for every patient
● 1-2 MDs available
● Pet therapy available
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application
(9th ed., pp. 306). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Patient Focus &
Staff Focus
● Patient focus
○ “Care should be organized first and foremost around the needs
of the patient.”
● Staff focus
○ “Increased opportunity for employee growth: When employees
are in jobs that they have outgrown, their productivity is often
reduced. Performance is better when placed in jobs that fit them
and provide new challenges.
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed., pp. 270, 364). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Interdependence of
Care Team
● “Teamwork and collaboration is a function effectively...fostering
open communication, mutual respect, and shared decision making”.
● Collaboration with MDs, PT/OT, respiratory, etc.
● Some nurses are specially trained
● Preceptors advocate for new orientees
● Staffing of PCTs
● Volunteers available

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed., pp. xix). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Use of Information
and Healthcare Technology
● The use of “information and technology to communicate, manage
knowledge, mitigate error, and support decision making.”
● EMR- Cerner
● Battery-rechargeable phones
● Tube system
● WOWs, computer stations, TV monitors
● Doorbell with a camera

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed., pp. xix). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Process for
Healthcare Delivery Improvement
Activities
● “Outcome audits determine what results, if any, occurred as a
result of specific nursing interventions for patients...assumes that
an outcome accurately demonstrates the quality of care that was
provided.”
● Outcome audits
○ CLABSIs, CAUTIs, falls, C-Diff
● Joint Commission visits/quality and safety monitoring
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed., pp. 618). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Staff Performance
Patterns
● “Performance appraisals let employees know the level of
their job performance as well as any expectations that the
organization may have of them.”
● Employee of the month for nurses, PCTs, etc. and
employee of the year
● Daisy award
● Mandatory annual skills fair
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed., pp. 647). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Specific Aspect Targeted for
Improvement

● Staff/patient focus
● Decrease stress while also increasing patient quality of care
● Adding a communication facilitator to the staff can enhance
patient understanding and decrease healthcare costs
● Integrative nursing principle: person-centered and relationship-
based
Khandelwal, N., Benkeser, D., Coe, N. B., Engelberg, R. A., & Curtis, J. R. (2016). Economic feasibility of staffing the intensive
care unit with a communication facilitator. Annals of the American Thoracic Society 13(12), 2190-2196.
https://doi.org/10.1513/AnnalsATS.201606-449OC
Kreitzer, M. J. (2015). Integrative nursing: Application of principles across clinical settings. Rambam Maimonides Medical Journal
Leading the Plan for Healthcare Delivery
Improvement
Conduct employment
Determine eligibility interviews with best
criteria candidates

1 MONTH
PRESENT

< 1 MONTH <3 MONTHS

Post employment listing Hire a communication

for communication facilitator
facilitator
 References

Khandelwal, N., Benkeser, D., Coe, N. B., Engelberg, R. A., & Curtis, J. R. (2016). Economic feasibility of staffing the intensive care unit

with a communication facilitator. Annals of the American Thoracic Society 13(12), 2190-2196.

https://doi.org/10.1513/AnnalsATS.201606-449OC

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/Lippincott Williams & Wilkins.

Perez, L. (2019). Leadership & management & decision making [PowerPoint slides]. Retrieved from

https://d2l.arizona.edu/d2l/le/content/787890/viewContent/7276442/View
 Possible scholarly question

In what ways can a communication facilitator benefit an

intensive care unit? Select all that apply.

a. Decreases healthcare costs

b. Decreases family stress
c. Increases hospital stay
d. Increases patient satisfaction