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Healthcare Delivery Systems

Improvement Project

Hannah Ridinger
April 27, 2016

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Overview of Patient Care Delivery System
❧ Cardiovascular progressive care unit/ Cardiovascular
Telemetry
❧ Focus: Process improvement related to patient death in
the bathroom

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Microsystem Model:
Leadership
❧ Servant leaders, “put serving others, including
employees, customers, and the community as numberone priority”
❧ Overall supportive
❧ Manager and Charge RN go to staff meeting
❧ Servant-leader model

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management
functions in nursing: Theory and application (8th ed. p. 56). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.

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Microsystem Model:
Organizational Culture and Support
❧ “Management support, collegial influence, and the
interaction of personalities in the work group can have a
synergistic effect on motivation”
❧ Hospital-wide meeting
❧ “Huddle” every change of shift
❧ Rapid Response Team

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management
functions in nursing: Theory and application (8th ed. p. 415). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.

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Microsystem Model:
Patient Focus & Staff Focus
❧Patient Focus:
o“Recognize the patient...as the source of control
and full partner in providing compassionate and
coordinated care based on respect for patient’s
preferences, values and needs”
❧Staff Focus:
o“Nurses will be more satisfied...if staffing and
scheduling policies and procedures are thoughtfully
developed, fairly applied, and communicated to all
employees”
oStaff meetings every quarter
oCareer development
oBonus pay for covering shifts

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application
(8th ed. p. xiii, 406). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

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Microsystem Model:
Interdependence of Care Team
❧ Interdisciplinary teams promote “reduced

mortality and improved quality of life for patients,
a reduction in health-care costs, and a more
rewarding professional experience”
❧ TEMPO rounds
oCase manager, social worker, charge RN and
primary RN
❧ Physicians and nurses work in close proximity
❧ Tele monitor room communication
❧ Not enough voceras for all RNs
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management
functions in nursing: Theory and application (8th ed. p. 321). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.

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Microsystem Model:
Use of Information and Healthcare Technology
❧ “Nurses are increasingly using the internet as both a
communication tool and information source”
❧ Online systems for charting and reference manuals
❧Call lights function well
oSoft touch call lights also available
❧ Tele strips not available electronically
❧ Poor Wifi connection for WOWs
❧Vocera shortage

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management
functions in nursing: Theory and application (8th ed. p. 452). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.

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Microsystem Model:
Process for Healthcare Delivery Improvement
❧“Benchmarking is the process of measuring products,
practices, and services against best-performing
organizations”
❧Unit-Based Council discusses areas for change
❧ Use of benchmarking to implement mandatory bedside
report
❧Staff meetings often very inconvenient to attend

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management
functions in nursing: Theory and application (8th ed. p. 547). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.

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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”
❧ Performance appraisals of staff
❧ C-diff algorithm
❧ Inter-unit focus on statistics of patient outcomes
oFalls
oCAUTIs
oRe-admissions/length of stay
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management
functions in nursing: Theory and application (8th ed. p. 574). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.

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Specific Aspect Targeted for Improvement
❧ Evidence-Based: Cardiac arrest on the toilet: Clinical
characteristics and resuscitation profiles demonstrating
danger caregiver leaving patient on toilet.
❧Improving staff responsiveness to call-lights.
❧Cardiac arrest on the toilet
oLength of time left alone
oEarly detection
oFalls
Inamasu, J., & Miyatake, S. (2013). Cardiac arrest in the toilet: clinical characteristics and resuscitation profiles. Environmental
Health and Preventive Medicine, 18(2), 130-135. http://doi.org/10.1007/s12199-012-0301-y
Krauss, M. J., Evanoff, B., Hitcho, E., Ngugi, K. E., Dunagan, W. C., Fischer, I., … Fraser, V. J. (2005). A Case-control Study of
Patient, Medication, and Care-related Risk Factors for Inpatient Falls. Journal of General Internal Medicine, 20(2), 116–122.
http://doi.org/10.1111/j.1525-1497.2005.40171.
Williams, Doshia B.,(2014) Improving Staff Responsiveness to Patient-Initiated Call Lights. Master's Projects. Paper 57.

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Specific Aspect Targeted for Improvement
(cont.)
❧Process Improvement
❧Patients left in bathroom unattended for extended
periods of time, causing injury and death.
❧Nurse and/or PCT does not have the time to stay with
patient in the bathroom.
❧Proposed Intervention: Call light set to timer when
patient left in the bathroom
o Estimation of time set: q.3 min
Inamasu, J., & Miyatake, S. (2013). Cardiac arrest in the toilet: clinical characteristics and resuscitation profiles.
Environmental Health and Preventive Medicine, 18(2), 130-135. http://doi.org/10.1007/s12199-012-0301-y
Krauss, M. J., Evanoff, B., Hitcho, E., Ngugi, K. E., Dunagan, W. C., Fischer, I., … Fraser, V. J. (2005). A Case-control
Study of Patient, Medication, and Care-related Risk Factors for Inpatient Falls. Journal of General Internal Medicine,
20(2), 116–122. http://doi.org/10.1111/j.1525-1497.2005.40171.
Williams, Doshia B.,(2014) Improving Staff Responsiveness to Patient-Initiated Call Lights. Master's Projects. Paper
57.

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Leading the Plan for Healthcare Delivery
Improvement
❧ Presentation of project to staff:
oProvide patient data regarding cardiac arrest and
deaths occurring in bathroom (normative-empirical)
❧ Normative-reeducative method: Get informal leaders on board,
meet with them before you propose it to everyone
oIncorporate leaders into staff education program.
❧ Instal timers (approximately $5500)
❧ Education provided to RN’s and PCT’s on equipment
operations
❧ Process improvement evaluation and implementation hospital
wide.
Inamasu, J., & Miyatake, S. (2013). Cardiac arrest in the toilet: clinical characteristics and resuscitation profiles. Environmental
Health and Preventive Medicine, 18(2), 130-135. http://doi.org/10.1007/s12199-012-0301-y
Krauss, M. J., Evanoff, B., Hitcho, E., Ngugi, K. E., Dunagan, W. C., Fischer, I., … Fraser, V. J. (2005). A Case-control Study of
Patient, Medication, and Care-related Risk Factors for Inpatient Falls. Journal of General Internal Medicine, 20(2), 116–122.
http://doi.org/10.1111/j.1525-1497.2005.40171.
Williams, Doshia B.,(2014) Improving Staff Responsiveness to Patient-Initiated Call Lights. Master's Projects. Paper 57.

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Timeline of Events

9-12 months
5-6 months
3-4 months
1 month
RootCause
analysis

Formulate
education
committee

Process
change
on unit

Evaluate
Unit-Wide
System

>1 year
Hospital
Wide

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References

❧ Inamasu, J., & Miyatake, S. (2013). Cardiac arrest in the toilet: clinical
characteristics and resuscitation profiles. Environmental Health and
Preventive Medicine, 18(2), 130-135. http://doi.org/10.1007/s12199-0120301-y
❧ Krauss, M. J., Evanoff, B., Hitcho, E., Ngugi, K. E., Dunagan, W. C.,
Fischer, I., … Fraser, V. J. (2005). A Case-control Study of Patient,
Medication, and Care-related Risk Factors for Inpatient Falls. Journal of
General Internal Medicine, 20(2), 116–122.
http://doi.org/10.1111/j.1525-1497.2005.40171.
❧ Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management
functions in nursing: Theory and application (8th ed.). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.
❧ Williams, Doshia B.,(2014) Improving Staff Responsiveness to PatientInitiated Call Lights. Master's Projects. Paper 57.

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