Improving Organizational Culture and

Support in Med-Surg at Northwest

Juliana Aldrich, Chelsea Lovitt, Ashley Nickell, Maddie Schaeffer &
🙠 Thompson
Bailee 🙢
December 2nd, 2020

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 Overview of Patient Care Delivery System

� Northwest Medical Center- Tucson

o Orthopedic Medical Surgical Unit- 80 bed unit
• Population mostly consists of post-surgical patients
including orthopedic, bariatric, and general surgery
• Ratio: up to 6:1
o Focus: Inadequate organizational support related to poor RN
to manager relationships secondary to impaired
communication, emotional strain, and burnout as evidenced
by nurses stating having a poor relationship with
management (K. Hesser, personal communication, November 20, 2020) 2
Microsystem Model: Leadership

� Ortho-Med Surg Leadership

o Charge RN leads in a democratic style
• “Less control, directed through suggestions
and guidance, communication flows up and
down, decision making involves others”
o Charge RN works to give constructive criticism
o Emphasis on team

Lacroix, D. (2020) Management and Leadership [Powerpoint slides]. Retrieved from

https://d2l.arizona.edu/d2l/le/content/906079/viewContent/8775559/View 3
Microsystem Model:
Organizational Culture and Support
� Culture:
o Democratic leadership
o Nurses help and respect each other
� Support:
o Charge RN always available
o Morning/night huddles
o House supervisors available
o Management not very approachable
Lacroix, D. (2020) Management and Leadership [Powerpoint slides]. Retrieved from 4
Microsystem Model:
Patient Focus & Staff Focus
� Patient Focus:
o Acuity tools used to help determine ratios
o Hourly rounding
o Patient care plans
� Staff Focus:
o New grad RN program
o Professional development encouraged
o Staff encouraged to further education
Johnson, J. K. (2001). Clinical microsystem assessment tool [PDF]. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf 5
Microsystem Model:
Interdependence of Care Team
� Large emphasis on trust, collaboration, willingness to
help, and respect
o Nurses felt safe asking others for help when
needed
� Mutual trust and respect between care team
o Nurses felt comfortable interacting with physicians
o Strong delegation process between nurses and
techs
Johnson, J. K. (2001). Clinical microsystem assessment tool [PDF]. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf 6
Microsystem Model:
Use of Information and Healthcare Technology
� Information with patients
o Patient portal, CareNotify
� Information with providers, staff, and technology
o Cerner EHR system, Omnicell
o WOWs, phones
o Communication via phone, Cerner, Omnicell

Johnson, J. K. (2001). Clinical microsystem assessment tool [PDF]. Retrieved from

http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
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Microsystem Model:
Process for Healthcare Delivery Improvement
� Process Improvement
o Bedside hand-off/report
o Interprofessional rounds with surgeons,
physicians, PT/OT, respiratory, nutrition and
case management as necessary
o Lack of support and opportunity for continuing
education and seeking higher certifications

Johnson, J. K. (2001). Clinical microsystem assessment tool [PDF]. Retrieved from

http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf 8
Microsystem Model:
Staff Performance Patterns
� Performance Monitoring
o Yearly self-evaluations
• Completed by unit RN on themselves and
reviewed/discussed with charge/nursing manger
o Positive recognition among staff members
o Weekly emails from nursing manger to unit
RNs

Johnson, J. K. (2001). Clinical microsystem assessment tool [PDF]. Retrieved from

http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf 9
 Specific Aspect Targeted for Improvement

� Monthly check-in through an anonymous survey

with questions to facilitate expression of nurse’s
opinions on what the current unit needs are
� Necessary to have an outlet for nurses to feel
heard and supported
� Integrative Principle: Human beings are whole
systems inseparable from their environments.
Kreitzer, M.J. & Koithan, M. (2019). Integrative nursing. New York: Oxford Press.
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Specific Aspect Targeted for Improvement

� Allows for nurse’s voices to be heard without

fear of judgement
� Patient-centered care will improve because
when nurses are better supported, they will be
better equipped for providing quality care

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Leading the Plan for Healthcare Delivery
Improvement
� 1 year plan
� 1st-7th of each month: Survey
o After each check-in, the unit manager will
evaluate implementation of top request from
nurses
� 15th of each month: Intervention for following
month announced

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References
� Lacroix, D. (2020) Management and Leadership [Powerpoint slides]. Retrieved from
https://d2l.arizona.edu/d2l/le/content/906079/viewContent/8775559/View
� Johnson, J. K. (2001). Clinical microsystem assessment tool [PDF]. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
� Kreitzer, M.J. & Koithan, M. (2019). Integrative nursing. New York: Oxford Press.

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