Concept Application Project:

Healthcare Delivery
❧ ❧
Trysha Hicks, Lauren Hoyos, Brooke Barney, Holly Hunt, Emily Kingsley

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Overview of Patient Care Delivery System

❧  Southern Arizona VA Healthcare System

❧  Unit: 2 South (Medical-Surgical, Orthopedic Unit)
❧  Focus:
o  Organizational Culture and Support
o  Lack of huddle at beginning of shift

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 Microsystem Model:Leadership

❧  Authoritarian: “strong control, communication

flows downward, decision making does not
involve others”
❧  Unit Manager and Clinical Nurse Leader attend
daily staff meetings
❧  Decentralized Decision Making/Staffing model

Lacroix, D. (2018). Management and Leadership [PowerPoint slides]. Retrieved from https://d2l.arizona.edu/d2l/le/content/645271/Home

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Marquis, B. L. & Huston, C. J. (2017c). Leadership roles and management functions in nursing: Theory and application. (9th ed., pp. 304). Philadelphia, PA:
Wolters Kluwer health/Lippincott Williams & Wilkins.
 Microsystem Mode
Organizational Culture and Support
❧  Flatline Organizational ❧  Excellent Organizational
Structure Support
o  Few or no levels of o  Senior Clinical Officer
management o  Nurse Manager
o  Supervises employees o  Clinical Nurse Lead
less o  Charge Nurse
o  Promotes involvement
in decision making
O’Connell, M. (2018). Organizational structure: The impact on patient care delivery [PowerPoint slides]. Retrieved from
https://d2l.arizona.edu/d2l/le/content/645271/Home
Marquis, B. L. & Huston, C. J. (2017c). Leadership roles and management functions in nursing: Theory and application. (9th ed., pp. 304). Philadelphia, PA: Wolters Kluwer
health/Lippincott Williams & Wilkins.
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 Microsystem Model:
Patient Focus & Staff Focus
❧  Patient focus: “suggest patient and family
centered care is an innovative approach to the
planning, delivery, and evaluation of healthcare”

❧  Staff Focus: “expectations of staff are high

regarding performance, continuing education,
professional growth, and networking”
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
❧  “There is a lack of collaboration and a lack of
appreciation for the importance of complementary
roles”

❧  Current State
o  Rare beginning of shift huddle
o  No interdisciplinary rounds
o  Lengthy process to contact providers
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Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
 Microsystem Model:
Use of Information and Healthcare Technology
❧  “Health IT can improve patient safety by evaluating
potential drug-drug interactions, compensating for
human errors in dosing, and eliminating mistakes caused
by illegible handwriting”

❧  Current State
o  Linked Resources
o  Pager phone use
o  Call lights properly functioning
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 don’t use them as often
as we could”

❧  Current State
o  Inconsistent huddle meetings

Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from http://www.ihi.org/resources/pages/tools/
clinicalmicrosystemassessmenttool.aspx 8
Microsystem Model: Staff Performance Patterns

❧  “Outcomes are routinely measured, we feed data

back to staff, and we make changes based on
data”
❧  Current State
o  Annual performance reviews
o  Available for upgrades
o  Nurse Manager frequent feedback
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from http://www.ihi.org/resources/pages/tools/
clinicalmicrosystemassessmenttool.aspx
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 Specific Aspect Targeted for Improvement

❧  Current State: lack of teamwork, communication,

and organization on the unit
❧  Nurse preference
❧  Benefit to shift change huddle
❧  Goal: Increase nurse communication to ensure
optimal patient care

Dutka, P. (2016). The huddle: It’s not just for football anymore. Nephrology Nursing Journal, 43(2), 161-162. Retrieved from https://
www.ncbi.nlm.nih.gov/pubmed/27254972
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Leading the Plan for Healthcare Delivery
Improvement
❧  Literature:
o  “Taking the time to come together to communicate about
patients improves awareness of the general state of the unit
and decreases chaos caused by poor communication.”
❧  Plan
o  Implement huddle for 6 months
o  Satisfaction surveys: end of every month and at 6 months
❧  General Guidelines expressed to staff:
o  All personnel required to attend, SECURE, 15 Min MAX
Dutka, P. (2016). The huddle: It’s not just for football anymore. Nephrology Nursing Journal, 43(2), 161-162. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27254972 11
 References
Dutka, P. (2016). The huddle: It’s not just for football anymore. Nephrology Nursing Journal, 43(2). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2725497211

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

Lacroix, D. (2018). Management and Leadership [PowerPoint slides]. Retrieved from https://d2l.arizona.edu/d2l/le/content/645271/Home

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.

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

O’Connell, M. (2018). Organizational structure: The impact on patient care delivery [PowerPoint slides]. Retrieved from https://d2l.arizona.edu/d2l/le/content/

645271/Home

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