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Overview of Patient Care Delivery System:
Total Patient Care

Healthcare Delivery Systems
Improvement Project

❧  Nurses assume total responsibility for their patients
during their time on duty. All patient needs are thus
directed towards the assigned nurse for the duration of
their shift.

Marlee Feinholz
Katherine Yeh
Kaitlyn Parks
Mary Sepulveda
Devyn Weber


Impact on the Delivery of Care
• Patient receives holistic and unfragmented care
during the nurse’s time on duty
• Shift change/different nurses can result in different
approaches to patient care
• Requires highly skilled personnel, causing a
disadvantage when the nurse is inadequately
prepared to provide complete patient care

December 2, 2015

(Marquis & Huston, 2009)


Microsystem Model:
Quantum Leadership

Microsystem Mode:
Organizational Culture and Support

❧  Managers must work together with their employees to
have common goals, exploit opportunities, and empower
staff to make decisions that promote organizational

❧  Banner University Medical Center



•  Mission
•  Vision
•  Innovation

❧  Assessing the Organizational Culture

Impact on Delivery of Care

• Physical Environment
• Social Environment
• Organizational Support
• Organization’s Power Structure
• Organization Safety
• Communication
• Organization Taboos

•  Plays a primary role in situations of rapid change and
needed transition (UAMC → Banner UMC)
•  Improves the unit’s organizational productivity, which
stems into the delivery of care
•  Impacts the innovative set of interactions and
relationships in the Trauma ICU, easing adaption to the
fluid, flexible, and mobile environment
(Marquis & Huston, 2009)


(Banner Health, 2015)

(Marquis & Huston, 2009)


Microsystem Model:
Interdependence of Care Team

Microsystem Model:
Patient Focus & Staff Focus
❧  Banner University Medical Center: Teaching Hospital
• “A hospital closely associated with a medical school,
serving as a practical educational site for medical
students, interns, residents, and allied health personnel.”
• Evidence-Based Practice
• Continual Research
• Health Care Workers
• Perspective
• Perception
• Patient Focused and Centered
• “Round the Clock” Physician Care
(Banner Health, 2015)


❧  Banner-UMC’s Trauma ICU takes a multidisciplinary
team leader approach.
❧  Incorporates pharmacists, social workers,
occupational therapists, speech therapists, and other
health care workers as part of a multidisciplinary team
to assure that comprehensive and holistic health care
can be provided to each patient

❧  Impact on Care
•  Requires Efficient Communication
•  Requires Whole Team Meeting
•  Reduced Patient Mortality & Improved Quality of Life
(Marquis & Huston, 2009)




Microsystem Model:
Use of Information and Healthcare Technology


Microsystem Model:
Process for Healthcare Delivery Improvement

“Technology has given us the potential for instant
information access and exchange”
Banner-UMC Trauma ICU utilizes and accepts
technology as an adjunct to their nursing cognizance.

❧ Microsystems improve many aspects of clinical
❧  Process improvement in the Trauma ICU:
• Successful Process Improvement program:
• Event identification
• Corrective action plans
• Methods of monitoring
• Reevaluation
• Benchmarking
• Achieving problem resolution

Impact on Care
•  Internet for communication and information
•  Hospital Information System and Intranet
•  Social Media and Organizational Communication

(Marquis & Huston, 2009)


Microsystem Model:
Staff Performance Patterns

(Center for Health-System Pharmacy Development, 2011) (Pidgeon, 2015)


Specific Aspect Targeted for Improvement
❧ The culture of Trauma ICU: The demands of this
specialty can lead to frustration, burnout, tension in the
workplace, and increased job dissatisfaction.

❧ Performance Evaluation in the Trauma ICU
• Staff performance evaluation form
• Needs Improvement, Meets or Exceeds
• Annual meeting with unit manager to review
• Education and remediation in areas that need
improvement or correction

❧ How to improve this culture → Culture of Mentorship,
which is conducive to fostering growth
• Maximizes a nurse’s career potential
• Enhance career development
• Prepare the nurse for potential leadership roles

(S.J., personal communication, November 19, 2015)


❧ A culture that fosters mentorship produces:
•  Improved job satisfaction
•  Promotes professional development and empowerment

amongst staff
•  Results in high quality healthcare
•  Improved patient outcomes

of an effective mentoring program:

• Safer and more competent nursing practice

(Race & Skees, 2010)


Leading the Plan for Healthcare Delivery

Specific Aspect Targeted for Improvement


(Race & Skees, 2010)


❧  Key Elements to Sustain a Mentoring Program
• A stable infrastructure
• Managerial and executive support
• Schedule flexibility
• Incentives
• Recognition
❧ Strategies for Successful Role Transition & Professional
• The National League for Nursing Tool Kit
• Mentorship facilitator/coordinator
• Collegial mentoring model
• Formal vs. informal mentoring program
• Learning needs assessments
• Careful mentoring
(Race & Skees, 2010)
• Reward mechanisms





Banner Health. (2014). Banner code of conduct. Retrieved

Center for Health-System Pharmacy Development. (2011).
Understanding high performing clinical microsystems.
Retrieved from

Banner Health. (2015). Our nonprofit mission. Retrieved

Marquis, B.L., & Huston, C.J. (2009). Leadership roles and
management functions in nursing: Theory and application.
(8th ed.). Philadelphia, PA: Wolters Kluwer Health/
Lippincott Williams & Wilkins.


Pidgeon, K. (2015). The genesis of a trauma performance
improvement plan. Journal of Trauma Nursing, 22(6),
315-320. doi:10.1097/JTN.0000000000000166