Healthcare Delivery Systems

Improvement Project
Kyra Barstad, Kalyn Morimoto, Daniel Reavis, Haley Small,
and Lindsay Weigel

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 Overview of Patient Care Delivery System

❏ St. Joseph’s Hospital

❏ Postpartum/Couplet Care Unit, a 34-bed unit

❏ Team members consist of PCTs, registered nurses,

charge nurse, lactation consultant, house supervisor,
neonatal nurse practitioners, and
obstetrics/gynecological physicians.

❏ Focus: Impaired interdependence of healthcare team

related to ineffective communication and role confusion,
and inadequate performance due to a lack of preparation
for emergent situations, and lack of resources, and
horizontal violence during rapid-responses.

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 Microsystem Model:
Leadership

❏ Charge Nurse or Clinical Nurse Leader provides

leadership for the unit
❏ 3 Charge Nurses, 1 Clinical Nurse Leader
❏ Democratic leadership style.
❏ “Less control, economic and ego awards are used,
directed through suggestions and guidance,
communication flows up and down, decision making
involves others”
❏ Goals and expectations are clear
❏ Consistency of Charge RN

(Johnson, 2001), (Marquis & Huston, 2017) 3

 Microsystem Model:
Organizational Culture and Support

❏ Unit Management
❏ Nurse manager - democratic style
❏ staffinvolved in decision making
❏ leads with guidance

❏ Organizational Culture
❏ Handoff report/transfer of care

❏ No huddle at shift change

(Johnson, 2001), (Marquis & Huston, 2017) 4

 Microsystem Model:
Patient/Staff Focus of Healthcare Delivery

❏ Patient Focus: ❏ Staff Focus:

❏ Continuity of Care ❏ Required

❏ Patient Education orientation for new

❏Lactation hires
Consultants ❏ Couplet:Nurse
❏ Hourly Rounding ratios of 4:1
❏ Cluster Care ❏ Required education
❏ Quality Care modules

(Johnson, 2001) 5
Microsystem Model:
Interdependence of Care Team

❏ Trust, collaboration, willingness to help, appreciation of

complementary roles, respect and recognition among staff.
❏ Methods
❏Meetings with charge nurse and trust among RNs
❏Shared purpose and collaboration among
interdisciplinary staff
❏Communication with EHR and Voceras
❏ Observations
❏RNs work closely and collaborate with PCTs
❏Role confusion, lack of structure, horizontal violence
during emergency response.
(Huth, Kelly, & Van Sell, 2017) (Johnson, 2001) 6
 Microsystem Model:
Use of Information and Healthcare Technology

❏ Patients
❏ Access to patient portal (My Health Rec)
❏ Medical Records department
❏ Vaccination Information Statements
❏ Staff and Providers
❏ Utilize a combination of EHR (Cerner) and paper-charting
❏Information found in the paper chart includes doctor’s
orders, care plans, and pregnancy history.
❏ Technology
❏ Vocera Badge
❏ Utilization of an EHR
❏ Pyxis
❏ Computers available at the nurses’ station and in the
patients’ rooms.
(Johnson, 2001), (Centers for Disease Control and Prevention, n.d.), (Carondelet Health Network, n.d.-a) 7
 Microsystem Model:
Process for Healthcare Delivery Improvement Activities

❏ Carondelet hospitals are guided by five core values;

two of these values are quality and innovation.
❏ Blue Cross Blue Shield Blue Distinction Center+ for
Maternity Care
❏ NOELLE® Maternal Birthing Simulator
❏ Continuing education and training hours are offered
and highly encouraged
❏ Documentation audits
❏ No huddles

(Johnson, 2001), (Carondelet Health Network, n.d.-b), (Blue Cross Blue Shield, n.d.), (Marquis & Huston, 2017) 8
 Microsystem Model:
Staff Performance Patterns

❏ Performance appraisals involve ongoing communication

with staff and set clear, achievable expectations and
goals. Ideally these promote employee growth in work
performance

❏ Feedback
❏ Ongoing communication with charge nurse and staff
❏ Performance indicators are discussed with staff
❏ Bi-annual performance review
❏ Focus on quality assurance and improvement

(Marquis & Huston, 2017)

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 Specific Aspect Targeted for Improvement

❏ Infant Emergency Response Organization

❏ Interdependence of healthcare team related to ineffective
communication and role confusion, and inadequate
performance due to a lack of preparation for emergent
situations, and lack of resources, and horizontal violence
during rapid-responses.
❏Simulation-based trainings and gratitude practices
❏Role distinction

(Jnah, Newberry, and Trembath, 2016)

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Leading the Plan for Healthcare Delivery
Improvement

❏ Evidence-Based Practice
❏ Neonatal Resuscitation Training simulations can
result in optimal team function and reduction in errors
❏Must be realistic with varied scenarios
❏ Integrative Nursing Principle #6
❏ “Integrative nursing focuses on the health and
wellbeing of caregivers as well as those they serve.”
❏ Includes reflective practices such as those included in
SBTs and gratitude journaling

(Kreitzer, 2015) (Jnah, Newberry, and Trembath, 2016)

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 Intervention Process

Project Timeline

Evaluate intervention outcomes

Project planning and and apply to other units at St.
goal-setting Education on intervention Joseph’s Hospital
Months 1-3 Months 4-6

Months 0-1 Months 3-4

Assessment of couplet unit Begin SBTs and data Months 6+
employee satisfaction with collection on couplet unit
communication, role
designation, and performance
during emergencies

(Jnah, Newberry, and Trembath, 2016) 12

 THE END

❏ “Interdependence has been known to create

transformation, or change, which comes from a
shared vision of a future. Multiple parts of a care
team come together to make the whole and create
transformation in the healthcare setting and change
for the patient”. (Huth, Kelly, & Van Sell, 2017).

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References

Blue Cross Blue Shield (n.d.). Blue distinction centers. Retrieved from https://www.bcbs.com/blue-distinction-center/facility

Carondelet Health Network (n.d.-a). Portal. Retrieved from https://www.carondelet.org/portal

Carondelet Health Network (n.d.-b). Mission, vision and values. Retrieved from
https://www.carondelet.org/about/mission-vision-and-values

Centers for Disease Control and Prevention (n.d.). Vaccine information statements (VIS)s.
Retrieved from
https://www.cdc.gov/vaccines/hcp/vis/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%
2Fpubs%2Fvis%2Fdefault.htm

Huth, C., Kelly, B., & Van Sell, S. L. (2017). Interdependence: A concept
analysis. International Journal of Nursing and Clinical Practices 4(225),
1-4. doi: 10.15344/2394-4978/2017/225.

Jnah, Amy, DNP, APRN, Newberry, Desi, DNP, APRN, Trembath, Andrea, MD, MPH, et al.
(2016). Neonatal Resuscitation Training: Implications of Course Construct and Discipline
Compartmentalization on Role Confusion and Role Ambiguity. Advances in Neonatal Care, 16, 201-210.
https://doi.org/10.1097/ANC.0000000000000294 14
References

Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from

http://clinicalmicrosystem.org/uploads/documents/microsystem_ assessment.pdf

Kreitzer, M. J. (2015). Integrative nursing: Application of principles across

clinical settings. Rambam Maimonides Medical Journal, 6(2). doi: 10.5041/RMMJ.10200

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management

functions in nursing: theory and application (9th ed). Philadelphia: Wolters Kluwer Health.

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