Healthcare Delivery Systems

Improvement Project

Tanya Darkwah, Ashley Hobbs, Alma Lozano, Rebecca Paoli, Claritza Sanchez
April 26, 2017

1
Overview of Patient Care Delivery System

Tucson Medical Center (TMC)

Mother/Baby Unit
Focus: Education and training related to adverse or
emergency events

2
 Microsystem Model:
Leadership

Leaders maintain constancy of purpose, establish clear goals

and expectations, and foster a respectful positive culture.
Leaders take time to build knowledge, review and reflect, and
take action about microsystems and the larger organization. 1
Democratic Leadership 2
Decentralized 3
RN opinions/preferences are considered
1. Institute for Healthcare Improvement.(2017). Clinical microsystem assessment tool. Retrieved from:
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
2. Marquis, B.L., & Huston, C.J. (2015a). Leadership roles and management functions in nursing theory and application (8th ed., pp. 40).
Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
3. Marquis, B.L., & Huston, C.J. (2015b). Leadership roles and management functions in nursing theory and application (8th ed., pp. 390).
Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
3
 Microsystem Mode
Organizational Culture and Support
The larger organization provides recognition, information,
and resources that enhance my work and makes it easier for
me to meet the needs of patients.1
Employer provides tuition reimbursement 3
Offer in-service opportunities 2
Employees acknowledged for additional efforts 2

1. Institute for Healthcare Improvement.(2017). Clinical microsystem assessment tool. Retrieved from:
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
2. Marquis, B.L., & Huston, C.J. (2015c). Leadership roles and management functions in nursing theory and application (8th ed., pp. 274-276).
Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
3. Tucson Medical Center. (n.d.). Benefits at TMC. Retrieved from http://jobs.tmcaz.com/benefits 4
 Microsystem Model:
Interdependence of Care Team
Care is provided by an interdisciplinary team characterized
by trust, collaboration, appreciation of complementary roles,
and a recognition that all contribute individually to a shared
purpose. 1
Care teams consist of:
oPhysicians, Nurse Practitioners, Midwives, RNs,
LPN/LVNs, PCTs, Lactation Consultants, Social Workers
Medical Residents, Nursing Students

1. Institute for Healthcare Improvement.(2017). Clinical microsystem assessment tool. Retrieved from:
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx 5
 Microsystem Model:
Patient Focus & Staff Focus
Staff Focus
oI am a valued member of the microsystem and what I say
matters. This is evident through staffing, education and
training, workload, and professional growth. 1
oRNs are involved in staffing and decision making
Patient Focus
oWe are actively working to provide patient centered care
and we are making progress toward more effectively and
consistently learning about and meeting patient needs. 1
oBedside report is encouraged but not always implemented
1. Institute for Healthcare Improvement.(2017). Clinical microsystem assessment tool. Retrieved from:
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx 6
 Microsystem Model:
Use of Information and Healthcare Technology
Patients have a variety of ways to get the information they need and it
can be customized to meet their individual learning styles. We routinely
ask patients for feedback about how to improve the information we give
them. 1
The information I need to do my work is available when I need it. 1
Technology facilitates a smooth linkage between information and
patient care by providing timely, effective access to a rich information
environment. The information environment has been designed to
support the work of the clinical unit. 1
o http://bilitool.info/ 2
1. Institute for Healthcare Improvement.(2017). Clinical microsystem assessment tool. Retrieved from:
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
2. BiliTool, Inc. (2016). BiliTool. Retrieved from: http://bilitool.org/ 7
 Microsystem Model:
Process for Healthcare Delivery Improvement
There are ample resources to support continual improvement
work. Studying, measuring and improving care in a scientific
way are essential parts of our daily work. 1
oSuggestions for improvement are presented and
continually reinforced during morning huddles
oPPH events are measured and tracked

1. Institute for Healthcare Improvement.(2017). Clinical microsystem assessment tool. Retrieved from:
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx 8
 Microsystem Model:
Staff Performance Patterns
Outcomes (clinical, satisfaction, financial, technical, safety)
are routinely measured, we feed data back to staff, and we
make changes based on data. 1
oMedication discrepancies/errors monitored
oUnit managers frequently round to assess patient
satisfaction
oAnnual staff reviews

1. Institute for Healthcare Improvement.(2017). Clinical microsystem assessment tool. Retrieved from:
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx 9
 Specific Aspect Targeted for Improvement

Performance Patterns
oEducation and training: emergency events
Simulations, training, etc.
oFocus on nursing staff
oPast events have indicated a need for practicing nurses to
remain up to date with clinical skills not used daily (due to
specialization within the nursing field) 1
Goal: Improve staff response and patient outcomes during
adverse and emergency events

1. Walker, M., & Stevenson, G. (2016). Learning Theory Support of Simulation to Improve Nurses' Care of Critically Ill Patients. The Journal of Continuing
Education in Nursing, 47(1), 27-31. 10
 Specific Aspect Targeted for Improvement (cont.)

Current Studies:
o Simulation is increasingly being used in healthcare education
to teach cognitive, psychomotor, and affective skills 1
Well-used in nursing schools, but not among practicing
nurses 2
oSimulation learning improves skills and helps with skill
retention 1
oSimulations and training decrease the risk of negative
outcomes 1
1. Motola, I., Devine, L. A., Chung, H. S., Sullivan, J. E., & Issenberg, S. B. (2013). Simulation in healthcare education: a best evidence practical
guide. AMEE Guide No. 82. Medical Teacher, 35(10), e1511-e1530.
2. Walker, M., & Stevenson, G. (2016). Learning Theory Support of Simulation to Improve Nurses' Care of Critically Ill Patients. The Journal of
Continuing Education in Nursing, 47(1), 27-31. 11
 Leading the Plan for Healthcare Delivery
Improvement
Curriculum Integration:
1. Plan
2. Implement
3. Evaluate
4. Revise
. Team composed of: educator/course director, content
expert, and simulation technician
Plan Implement Evaluate & Revise
month 0-3 month 3-4 month 4-6
Motola, I., Devine, L. A., Chung, H. S., Sullivan, J. E., & Issenberg, S. B. (2013). Simulation in healthcare education: a best evidence practical
guide. AMEE Guide No. 82. Medical Teacher, 35(10), e1511-e1530. 12
 References
BiliTool, Inc. (2016). BiliTool. Retrieved from: http://bilitool.org/

Institute for Healthcare Improvement.(2017). Clinical microsystem assessment tool. Retrieved from:

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

Marquis, B.L., & Huston, C.J. (2015a). Leadership roles and management functions in nursing theory and application (8th ed., pp.

40). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.

Marquis, B.L., & Huston, C.J. (2015b). Leadership roles and management functions in nursing theory and application (8th ed., pp.

390). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.

Marquis, B.L., & Huston, C.J. (2015c). Leadership roles and management functions in nursing theory and application (8th ed., pp.

274-276). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.

Motola, I., Devine, L. A., Chung, H. S., Sullivan, J. E., & Issenberg, S. B. (2013). Simulation in healthcare education: a best evidence

practical guide. AMEE Guide No. 82. Medical Teacher, 35(10), e1511-e1530.
13
References (cont.)
Tucson Medical Center (n.d.). Benefits at TMC. Retrieved from http://jobs.tmcaz.com/benefits

Tucson Medical Center (n.d.). Mission, Vision, and Values. Retrieved from https://www.tmcaz.com/mission-vision-values

Walker, M., & Stevenson, G. (2016). Learning Theory Support of Simulation to Improve Nurses' Care of Critically Ill Patients. The

Journal of Continuing Education in Nursing, 47(1), 27-31.