Quality

Improvement
Project:
Leadership

Ashley Dohr, Kylie Wong, Lexi

Raim, Maddy Crouch
11/28/18

1
 2 Overview of Patient Care
Delivery System

• Southern Arizona Veteran's Affairs Health Care

Systems (SAVAHCS)
• Step Down Unit
• Focus: Leadership- charge nurse, unit manager,
and the senior clinical officer (SCO)
 3 Microsystem Model:
Leadership

• Transactional: traditional management

style that is focused on they daily
operations
oSCO rounding
oCharge nurses rounding
oImproved support

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 4 Microsystem Mode
Organizational Culture and
Support
• Organizational Culture: “total of an organization's values,
language, traditions, customs, and sacred cows—those few
things present in an institution that are not open to discussion or
change”
o Morning Huddle
o Rapid Response Team
o Code Green Team
o Code Yellow
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. p. 305). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 5 Microsystem Model:
Staff Focus

• Staff Focus: “cost-effective method of increasing

productivity”
oDecentralized Staffing
oNursing Ladder
oWorking 36 for 40
 Extra 8-hour shift
oBenefits

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. p. 411). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 6 Microsystem Model:
Patient Focus & IN
Principle
• Patient Focus: “based on the premise that care
should be organized first and foremost around the
needs of the patients”
oContinuity of care
oPod nursing
oSAVAHCS “ICARE” mission statement
• IN Principle: #3 nature has healing and restorative
properties that contribute to health and wellbeing

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. p. 364). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 7 Microsystem Model:
Interdependence of Care Team

• “The interaction of staff is characterized by trust,

collaboration, willingness to help each other,
appreciation of complementary roles, and a recognition
that all contribute individually to a shared purpose.”
oRounding of the Medicine team
oVariety of professions easily available for assistance
oRespiratory Therapists are on unit or easily reached

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 8 Microsystem Model:
Use of Information and
Healthcare Technology
• Technology has radically changed how nurses chart and
communicate the patient information.
o 3 different charting systems
o Computer on Wheels (COW)
o Limited amount of computers in nurses station
o Touch call lights
o Nurse trackers
o Telemetry and continuous vital monitoring
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 9 Microsystem Model:
Process for Healthcare Delivery
Improvement
• Benchmarking: “the process of measuring products, practices,
and services against best performing organization”
• Best practice programs aim to follow practices/protocols that
improve quality of life, quality of care, staff development, or
cost-effectiveness practices.
o Quality Improvement Project
o Unit based council
o Foley protocol
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. p. 614). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 10 Microsystem Model:
Staff Performance Patterns
• Performance appraisals assess how well the employee is
performing their duties of their job in indication to their job
description or some other pre-specified criteria
o Hospital Wide:
 Yearly employee evaluations
 DAISY award
o Unit wide:
 Falls
 CAUTIs
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 11 Specific Aspect Targeted for
Improvement and Integrative
Modality
• Leadership
oNot enough training for the charge nurse
oWhen people call in sick it causes people to have to
shift roles
 12 Specific Aspect Targeted for
Improvement and Integrative
Modality (cont.)
• Evidenced-Based: The implementation of a structured
nursing leadership development program for
succession planning in a health system
o Limited pool of nursing leaders
o Benefits outweighed the negative
o Views of nursing leadership development process
o Outcomes
Ramseur, P., Fuchs, M.A., Edwards, P., & Humphreys, J. (2018). The implementation of a structured nursing leadership
development program for succession planning in a health system. The Journal of Nursing Administration.. 48(1). 25-30. Doi:
10.1097/NNA.0000000000000566
 13 Leading the Plan for Healthcare
Delivery Improvement

• Presentation of project to SCO and unit manager

• Rational-Empirical strategy: “give current research as evidence
to support the change” (193)
o Provide education on research found to SCO and unit manager
• Educate all the nurses on the unit of the importance of proper
training to be in a leader ship role
• Implement ENMO and NLDP programs onto the unit along with
a mentor
• Conduct a process improvement evaluation
• Eventually implement hospital wide
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 14 Timeline

1 Month: Route Cause Analysis

2-3 Months: Educate leaders on programs &

importance of a mentor

4-6 Months: Implement programs and assign

mentors

7-10: Nurse acting as a leader independently

1 year: Evaluation, adjust and implement

hospital-wide
15 Questions
 16 References

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

and management functions in nursing: Theory and
application (9th ed.). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.
• Ramseur, P., Fuchs, M.A., Edwards, P., & Humphreys, J. (2018).
The implementation of a structured nursing leadership
development program for succession planning in a health
system. The Journal of Nursing Administration.. 48(1). 25-30.
Doi: 10.1097/NNA.0000000000000566