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

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 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.

5
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
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
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:
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 7
 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
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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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