Improving Organizational

Culture
of the Healthcare Team
Danika Acosta, Nicole Arreaga, Kaitlyn Hopkins, Becky Patty, Kayla Sonderman
Overview of Patient Care Delivery
System
Tucson Medical Center
● Neuro Unit
○ 30-bed inpatient unit staffed by neuro-certified nurses
■ Includes nine intensive-observation (IO) beds
○ Physicians, RNs, nurse leadership, unit manager, PCTs, pharmacists,
psychiatry, RT, PT, OT, SLP, dietitian, case managers, unit clerk, rapid
response nurse

● Focus:
○ Neuro unit staff RNs and Emergency Department (ED) staff RNs
○ Impaired trust and communication of healthcare teams related to
incomplete assessments and lack of structured handover process.
Microsystem Model: Leadership
Neuro Unit Leadership
● Unit Manager and Charge Nurse
● Servant, Authentic, and Quantum leadership
● Helped nurses when overwhelmed and helped teach student nurses
● Inspired staff nurses and set an example to help their colleagues
manage their workload
● Empowered staff to play an active role in unit management and
improvement

(Johnson, 2001)
(Marquis & Huston, 2017)
Microsystem Model:
Organizational Culture and Support
Unit Management
● Respect and consideration
● Aim to complete tasks before the
oncoming shift takes over
● Huddle before every shift with
unit nurses
● Daily scheduled discussions of
discharge planning
○ Multidisciplinary team discussed
progression of care every day
● Staff eager to help each other
Interunit Relations
● Differing expectations on
information exchange
● Distrust of nursing
assessments and reports
● Dissatisfaction with patient
condition on arrival to unit
(Johnson, 2001)
(Marquis & Huston, 2017)
Microsystem Model:
Patient/Staff Focus of Healthcare
Delivery
Culture and Work Roles
● Unit manager interviews
oncoming staff, along with
peer interviews
● One year of training in the new
grad residency program
● Staff ratio 3:1 on IO and 5:1 on
floor
● Cactus stickers recognize good
patient care with emphasized
recognition during huddles
Listening and Caring
● Structured and thorough shift-
change reports
● Staffing measures to improve
patient understanding and
comfort
● Staff RNs are active
participants in educating
students on the unit
(Johnson, 2001)
Microsystem Model:
Interdependence of Care Team
● Collaboration within the team
● Trust between doctors and nurses
● Patient care huddle between the charge nurse, unit manager,
case manager, dietician, and OT/PT
● Staff encouraged to ask for help
● PCTs were professional and worked diligently
● Consistent team members within the unit
● Rapid response performed daily check-ins

(Johnson, 2001)
Microsystem Model: Use of
Information
and Healthcare Technology
● Epic EMR
● Voceras available for nurses
● Computers in every room and around the unit
● Pyxis located in the hallway
● Bed alarms, Hi-Lo beds, and fall mats
● Telemetry available for IO patients
● Monitors at nurses’ station with IO patient vitals
● Tube system for sending labs and receiving medications

● Issues with physician answering service; nurses often unable to reach

certain physicians
(Johnson, 2001)
Microsystem Model: Process for
Healthcare Delivery Improvement
Activities
● Continued education supported, such as support for ADN to
BSN staff members
● Specialized staff available to support unit and provide care
○ Vascular Access Team, wound care, dialysis nurse, diabetes
specialist
● Never events monitoring and prevention
○ Falls
○ Skin breakdown
○ Hospital-acquired infections
● Emphasis during daily huddle on providing patient hygiene care
(Johnson, 2001)
Microsystem Model:
Staff Performance Patterns
● Individual performance rewards
● Charge nurse provides positive and constructive comments to
staff nurses
● Charge nurse audits staff nurses bedside report regularly
● Annual performance review
● Outcomes data collected and monitored to find gaps in care

(Johnson, 2001)
Specific Aspect Targeted for
Improvement:
Organizational Specific
Culture Aspect: Organizational Culture
● Impaired trust and communication of
Present healthcare teams related to incomplete
Vital signs assessments and lack of structured
handover process
Intake and output
Treatment and diagnosis ● Improving interunit relationship by
developing a standardized handover
Admission and discharge ○ P-VITAL handover process
Legal issues ○ Provides a structured format
○ Ensures that all pertinent information is
collected and communicated (Wilson, 2011)
Integrative Nursing Principle
Integrative Nursing Principle # 4

“Integrative nursing is person-centered and relationship-based.”

● Improving communication and reducing instances of confusion and
resentment
● Holistic approach to data transfer ensures that patient-centered care
is delivered

(Kreitzer, 2015)
Project Timeline
Development: Implement:
Evaluate:
-Nurse leadership from
-Staff complete survey -Adjust tool as needed
Neuro unit and ED
to assess efficacy and -Implementation of P-
meet to discuss P-
perceptions. VITAL handover tool
VITAL tool

Month 1 Month 9 Months 11-12

Months 2-8 Month 10

Test: Improvement:
-Neuro and ED RNs oriented -Analyze staff surveys
-Testing of P-VITAL handover -Identify further
tool improvements
References
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_
assessment.pdf
Kreitzer, M. J. (2015). Integrative nursing: Application of principles across clinical
settings. Rambam Maimonides Medical Journal, 6(2). doi: 10.5041/RMMJ.10200
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in
nursing: Theory and application (9th ed). Philadelphia: Wolters Kluwer Health.
Wilson, R. (2011). Improving clinical handover in emergency departments. Emergency
Nurse, 19(1), 22–26. doi: 10.7748/en2011.04.19.1.22.c8446