Healthcare Delivery Systems

Improvement Project

Lauren King, Melina Miller, Elle Pavelonis, Taylor Romero, Alexa Stallworth
November 15, 2017

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Overview of Patient Care Delivery System

Oro Valley Hospital

Intensive Care Unit
Focus
o Interdependence of ICU staff
o Lack of huddle at beginning of shift

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Microsystem Model:
Leadership

Decentralized

Laissez- faire
o Permissive leadership style
o Small amount of direction
o Lack of criticism
o Group decision making

Marquis, B.L., & Huston, C.J. (2017a). Leadership roles and management functions in nursing: Theory and application (9th
ed., pp. 47). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
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Microsystem Model:
Organizational Culture and Support

Matrix organization structure

o Focus on both product and function
o formal vertical and horizontal chain of command

Adequate organizational support

o House Supervisor
o ICU Manager

Marquis, B.L., & Huston, C.J. (2017b). Leadership roles and management functions in nursing: Theory and application (9th ed., pp. 303). Philadelphia, PA:
Wolters Kluwer health/ Lippincott Williams & Wilkins.

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Microsystem Model:
Patient Focus & Staff Focus

Patient Focus
o effective in learning and meeting patient needs-
caring, listening, educating, and responding to
special requests, and smooth service flow
o Care organized around patients needs
Staff Focus
o I am a valued member of the microsystem and
what I say matters.
o Educational skills workshops
o New Graduate Nurse Program
Marquis, B.L., & Huston, C.J. (2017c). Leadership roles and management functions in nursing: Theory and application (9th ed., pp. 364).
Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.

Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
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Microsystem Model:
Interdependence of Care Team

The care approach is interdisciplinary, but

we are not always able to work together as
an effective team.
Current state
o No beginning of shift huddle
o No interdisciplinary rounds
o Can easily get in contact with providers
o Collaboration occurs throughout shift on
individual basis
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx

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Microsystem Model:
Use of Information and Healthcare Technology

Convenient access to real time information is

essential for managing health and care
Technology on the unit
o Informational systems to personalize patient
care education
o Cerner
o Available access to medical records online

National Partnership for Women and Families. (2013). Top ten consumer benefits of heath information technology [Fact sheet]. Retrieved from
http://www.nationalpartnership.org/research-library/health-care/HIT/top-ten-consumer-benefits-of-hit.pdf
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Microsystem Model:
Process for Healthcare Delivery Improvement

Some resources are available to support

improvement work, but we dont use them as
often as we could

Healthcare Improvement
o Benchmarking
o Fall risk bands
o Signage
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx

Marquis, B.L., & Huston, C.J. (2017d). Leadership roles and management functions in nursing: Theory and application
(9th ed., pp. 547). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.

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Microsystem Model:
Staff Performance Patterns

Outcomes are routinely measured and we

make changes based on data

Performance Appraisal
o Annual performance evaluation
o Eligible for salary increase
o Recognition for nurses

Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx

Marquis, B.L., & Huston, C.J. (2017e). Leadership roles and management functions in nursing: Theory and application (9th ed., pp. 551).
Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.

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Specific Aspect Targeted for Improvement

Disruption to current flow of unit

Individual nurse preference
Change of shift huddle benefits
o Stay informed
o Review Work
o Make plans for shift
Goal: Increase nurse communication and
general unit awareness

Institute for Healthcare Improvement. (2004). Huddles. Retrieved from http://www.ihi.org/resources/Pages/Tools/Huddles.aspx

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 Leading the Plan for Healthcare Delivery
Improvement

Literature: Huddles work because they create a

pattern of practice-level thinking, which is beneficial
to the process
Huddle Guidelines
o 15 minutes or less at beginning of shift
o All RN/PCT staff required to attend
o S.E.C.U.R.E.
Plan
o Implement for 1 month
o Administer satisfaction surveys

Dutka, P. (2016). The huddle: Its not just for football anymore. Nephrology Nursing Journal, 43(2). Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/27254972
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References

Dutka, P. (2016). The huddle: Its not just for football anymore. Nephrology Nursing Journal, 43(2).

Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27254972

Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from

http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx

Institute for Healthcare Improvement. (2004). Huddles. Retrieved from

http://www.ihi.org/resources/Pages/Tools/Huddles.aspx

Marquis, B.L., & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory

and application (9th ed., pp. 47, pp. 303, pp. 364, pp. 547, pp. 551). Philadelphia, PA: Wolters

Kluwer health/ Lippincott Williams & Wilkins.

National Partnership for Women and Families. (2013). Top ten consumer benefits of heath information

technology [Fact sheet]. Retrieved from http://www.nationalpartnership.org/research-

library/health-care/HIT/top-ten-consumer-benefits-of-hit.pdf

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