Good evening class,

Describe the selected problem from two of the three systems levels (micro-,
meso-, and macro).
     A practice issue in our cardiology practice is the high frequency of re-admissions for
CHF patients. Often times, many of our patients return after a multi-day stay in the
hospital for CHF exacerbation. This issue contributes to overcrowding in the hospital
and a decrease in reimbursement for re-hospitalization before a 30-day period.
     At the micro-level, the DNP scholar could create a list of outpatient clinics that
provide CHF outpatient care services and are low or no cost. In addition, we could
provide outpatient appointments for in-home evaluations for CHF core measures to
ensure patient adherence. Additionally, upon discharge, the primary nurse would
encourage the patient to establish care with a cardiologist and CHF clinic provider to
promote their overall health. 
     At the meso level, the DNP scholar can create a CHF core measure discharge
protocol with CHF prevention, education, and teachings to ensure safety and adherence
to treatment. Furthermore, the DNP scholar could create a CHF prevention program for
the healthcare organization which provides community resources for cost effective
medications, and nutrition assistance.
·        Explain how the outcomes of one system level effect the other level?
     The micro-system levels' outcomes affect the other levels when setting priorities and
expectations of the larger systems. According to Pandhi et al., (2018), it is essential to
maintain positive relationships between microsystems and larger meso and macro-
systems. Each level builds upon the success of the last and furthers the progress made
to improve upon the selected issue and outcomes.
·     How is a system approach beneficial in improving healthcare quality and
safety?
     Understanding the system relationships, challenging the status quo, and pushing
boundaries are associated with system improvements. Utilizing a systems approach
allows nursing to assess the current system and promotes patient-centered care,
teamwork, and collaboration (Stalter & Mota, 2018). This approach ultimately improves
nursing processes and supports high-quality care and enhances the existing patient
safety program. 
-Ellie
References
Pandhi, N., Kraft, S., Koslov, S., Kamnetz, S., Davis, S., Caplan, W., & Berson, S.,
(2018). Developing primary care teams prepared to improve quality: A mixed-methods
evaluation and lessons learned from implementing a microsystems approach. BMC
Health Services Researching. https://doi.org//10.1186/s12913-018-3650-4  (Links to an
external site.).
Stalter, A., & Mota, A. (2018). Using systems thinking to envision quality and safety in
healthcare. Nursing Management, 49(2), p. 32-39.