Healthcare Delivery Systems

Improvement Project

Misa Berndt, Tess Graettinger, Alysa Hackett, Kelli Kirschner,

Madi Will
November 16, 2016

Overview of Patient Care Delivery System

Banner University Medical Center, D5, Pediatric

Medical-Surgical Unit
Patient focus related to shift huddles and
interdependence of health care team
Patient demographics
o
o
o
o
o

36 bed unit
RNs: 25 total, 8-10 per shift
PCTs: 10 total, 2-3 per shift
Age range: 18 and under
Types of patients: Asthma, RSV, diabetes, trauma

(Michelle Knott, Personal Communication, 2016)

Microsystem Model:
Leadership
Leadership roles on the floor:
oCharge nurse
oClinical lead
oUnit manager
Democratic leadership style
Problem solving
Communication of policies/changes in care
(Bias, 2016)
(Michelle Knott, Personal Communication, 2016)
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Microsystem Model:
Organizational Culture and Support
The

floor fosters an environment of opencommunication so concerns can be addressed

and improvements can be made.
oFamily Oriented
oPositive
oCooperative
oSupportive

(Michelle Knott, Personal Communication, 2016)

Microsystem Model:
Patient Focus & Staff Focus
Microsystems

value staff input by having a

system in place to implement/integrate staffs
ideas/recommendations

Patient Centered Care

o Evidence Based Practice
o Hospital Protocol
o Compassion

(Michelle Knott, Personal Communication, 2016)

Microsystem Model:
Interdependence of Care Team
Understanding of role in patient care within scope
of practice
Ability to perform skills
Cooperation with team
Active participation in care
Effective communication
oBedside report
oTeam rounding
oPhysician orders can be retrieved from chart
Important changes in the plan of care may include
phone call from PCP to immediately implement
change
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(Michelle Knott, Personal Communication, 2016)

Microsystem Model:
Use of Information & Healthcare Technology
Information is sent and retrieved via computer
charting or unit mobile phones
oPatient information and POC
oPhysician orders
oCommunication with team members

Information resources available

oVirtual resources
oDiabetic educator
oTeddy bear book
oUnit co-workers or PICU nurses
(Michelle Knott, Personal Communication, 2016)

Microsystem Model:
Process for Healthcare Delivery Improvement

An atmosphere for learning and redesign is

supported by the continuous monitoring of care,
use of benchmarking, frequent tests of change,
and a staff that has been empowered to
innovate
(Foster, Johnson, Nelson, & Batalden, 2007)

Process improvements
o Annual competencies
o Problem solving meetings
o Standardized care
(Michelle Knott, Personal Communication, 2016)

Microsystem Model:
Staff Performance Patterns

Staff performance patterns result from a combination of

the patients, staff, and processes. Patterns reflect
routine ways of thinking, feeling, and behaving among
patients and staff. Evaluating these patterns allows for
the optimization of care.
(Godfrey, Nelson, Wasson, Mohr, Batalden, 2003)
Performance patterns and outcomes
o Patient satisfaction
o Length of hospitalization
o Annual performance reviews
(Michelle Knott, Personal Communication, 2016)
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Specific Aspect Targeted for Improvement

Plan: Incorporate start of shift huddles on the pediatric
floor at BUMC to improve the healthcare team and
interdependence as well as patient safety and quality
care
Rationale:
o Encourages continuous team building
o Increases staff satisfaction
oPromotes safe, high quality patient-centered care
o Enables organized problem analyses

(Duka, 2016)

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Specific Aspect Targeted for Improvement

Impact on the delivery of patient centered care

The Daily Readiness Huddle

ometrics review
oclinical volume review
odaily readiness assessment (S-MESA)
oproblem accountability
Results
orapidly identify issues
obring accountability to problem-solving
ofoster improvement
opositive effect on coordination and team-building
(Donnelly et al., 2016)

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Leading the Plan for Healthcare Delivery

Improvement
Prepare
Gather the team
Conduct the huddle
Conclude
Follow-up

(Wagner, Theel, & Handel, 2015)

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References
Bias, B. (2016) Management and Leadership
[PowerPoint slide]. Retrieved from d2l.arizona.edu
Donnelly, L. F., S. S., Chua, K. B., Thankachan, S.,
Millecker, L. A., Koroll, A. G., & Bisset, G. S. (2016). The
Daily Readiness Huddle: a process to rapidly identify
issues and foster improvement through problem-solving
accountability. Pediatric Radiology, 1-9.
Duka, P. (2016). The Huddle: Its Not Just for Football
Anymore. Nephrology Nursing Journal, 43(2), 161.
Foster, T., Johnson, J., Nelson, E., & Batalden, P. (2007).
Using a Malcolm Baldrige framework to understand high
performing clinical microsystems. Organisational
Matters, 16, 334-341.
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References
Godfrey, M., Nelson, E., Wasson, J., Mohr, J., &
Batalden, P. (2003). Microsystems in health care: part
3. planning patient-centered services. Joint Commission
Journal on Quality and Safety, 29(4), 159-170.
Knott, M. (2016, November 14). Personal interview.
Wagner, C., Theel, A., & Handel, S. (2015). Safety
Huddles - WSHA Home Page. Retrieved November 10,
2016, from
http://www.wsha.org/wp-content/uploads/Worker-Safety
_SafetyHuddle
Toolkit_3_27_15.pdf

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