IMPROVING EDUCATION &

TRAINING IN HEALTHCARE
By Alyssa Benefield, Brigid Clark, Samaria Gregorio, Emily Head & Angelica Painter
 OVERVIEW OF PATIENT CARE DELIVERY SYSTEM
Tucson Medical Center- Tucson

• Adult Medical Surgical (Unit 750), a 33 bed unit

• This unit cares for patient with multiple
diagnoses ranging from respiratory illnesses
to congestive heart failure to gastrointestinal
issues. It us a unique environment that needs
to have teamwork, compassion, time
management, and a broad knowledge of
multiple diagnoses.

• Focus:
• Ineffective education and training of
healthcare team related to poorly designated
training spaces and times
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 MICROSYSTEM MODEL:
LEADERSHIPS
Unit 750 Leadership

• Charge Nurse leadership style is Laissez-faire

• “permissive, little or no control, motivates by support,
provides little or no direction, up and downward
communication by group, places emphasis on group”

• Leadership in the microsystem

• Affects the quality of care that is being given on the unit

• Affects the type of education and training the staff is

Johnson, J. K. (2003). Clinical Microsystem assessment. Retrieved from https://d2l.arizona.edu/d2l/le/content/854111/viewContent/8098839/View

getting
Lacroix, D. (2020). Management and leadership {PowerPoint slides}. Retrieved from https://d2l.arizona.edu/d2l/le/content/854111/viewContent/8432037/View
Sfantou, D., Laliotis, A., Patelarou, A., Pistolla, D. S.-, Matalliotakis, M., & Patelarou, E. (2017). Importance of Leadership
Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review. Healthcare, 5(4), 73. doi: 3
10.3390/healthcare5040073
 MICROSYSTEM MODEL: ORGANIZATIONAL CULTURE
& SUPPORT
Unit 750 Management

• Culture:
• Strong nurse community built on trust and
respect
• Powerful morning huddles
• Support:
•Multitude of available resources “The larger organization
should look for ways to
•Nurses stations in the center of unit support the work for the
Johnson, J. K. (2003). Clinical Microsystem assessment. Retrieved from
https://d2l.arizona.edu/d2l/le/content/854111/viewContent/8098839/View microsystem”
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 MICROSYSTEM MODEL: PATIENT
FOCUS & STAFF FOCUS
• Patient Focus:
• Strong integrative focus, least invasive to most invasive model for pain
management
• Preventing CAUTI’s, falls, and maintaining/improving pressure ulcers
every shift.
• Hourly rounding to build a trusted nurse patient relationship
• Staff Focus:
• 5:1 average ratio
• New grads - one year commitment to specific unit
• Employee trainings - targeted area for improvement
Johnson, J. K. (2003). Clinical Microsystem assessment. Retrieved from https://d2l.arizona.edu/d2l/le/content/854111/viewContent/8098839/View

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 MICROSYSTEM MODEL: INTERDEPENDENCE OF
CARE TEAM
Organization, Communication, & Collaboration
• How care providers function within the microsystem
• Poor organization; very chaotic unit
• Nurses are very independent with each other and do
not collaborate often
• Nurses do not communicate with each other
• Physicians and nurses have good rapport

• Team supporting patient-centered care

• Patient-centered care not well supported
• Bedside Report
• Multiple barriers to patient-centered care
Johnson, J. K. (2003). Clinical Microsystem assessment. Retrieved from https://d2l.arizona.edu/d2l/le/content/854111/viewContent/8098839/View

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 MICROSYSTEM MODEL: USE OF
INFORMATION AND HEALTHCARE
TECHNOLOGY
Integration of information

• Information and healthcare technology on Unit 750?

• Epic EMR

• Medication safety database

• Vitals machine with built in computer

• Computers in the patient’s room → No mobile workstations

• Computers at the nurses station and near both pyxis’

• Vocera used to communicate between providers and staff

Johnson, J. K. (2003). Clinical Microsystem assessment. Retrieved from https://d2l.arizona.edu/d2l/le/content/854111/viewContent/8098839/View

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 MICROSYSTEM MODEL: PROCESS
FOR HEALTHCARE DELIVERY
IMPROVEMENT ACTIVITIES
Process Improvement
● Tracking “Never Events”
○ CAUTIS, Falls, pressure ulcers
● Morning Huddle
○ Updating staff on continuing education opportunities,
breaks in Never Events
● Bedside Report
● EPIC automatic notification of dramatic change in trend
○ Mandatory training for EPIC upon hiring
Johnson, J. K. (2003). Clinical Microsystem assessment. Retrieved from https://d2l.arizona.edu/d2l/le/content/854111/viewContent/8098839/View

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 MICROSYSTEM MODEL: STAFF
PERFORMANCE PATTERNS
Performance Results

• “Days since last fall” board in breakroom updated

regularly
• Data continuously collected via charting and compared
for outcomes
• Dual sign-off for insulin, 4 eye skin assessment
• Availability of specialty teams (IV, wound care)

Johnson, J. K. (2003). Clinical Microsystem assessment. Retrieved from https://d2l.arizona.edu/d2l/le/content/854111/viewContent/8098839/View

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 SPECIFIC ASPECT TARGETED FOR IMPROVEMENT
Enhancing organizational & collaborative skills through continuous in-service training
Rationale How to implement Positive Outcome
Insufficient training in the •Designated training •Increased skill
workplace can lead to room free from performance
high employee turnovers, interruptions •increased
low rates of production, •Set training times for communication/organ
unsafe work staff outside shift hours ization
environment, ineffective (Chaghari, Saffari, Ebadi, •Lower accidents/
staff management, and & Ameryoun, 2017) incidents reports
increased business •Increase overall
expense (Amo, 2019) productivity of the
unit (Ayed, Sayej, &
Thulth, 2015)
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 INTEGRATIVE NURSING PRINCIPLE

Integrative Nursing Principle #1: 1. Human beings

are whole systems inseparable from their
environments (Kreitzer, 2015)
● Changing training environment by lowering
distractions and increase focus will result in
better learning and better patient care
performance

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 PROJECT TIMELINE

Months
0-1 1-1.5 1.5 - 2 2-3 3-5

Identify Room
Post
trainings availability
Sign up evaluation
that & Training
sheet for of training
disrupt appropriate takes place
staff by self-
patient timing for
survey
care training

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 REFERENCES

Amo, T. (2019). The negative effects of lack of training in the workplace. Retrieved from:

https://smallbusiness.chron.com/negative-effects-lack-training-workplace-45171.html

Ayed, A., Sayej, S., & Thulth, A. (2015). Impact of Night Shift and Training Development Factors on Performance of

Professional Nurses in North West Bank Governmental Hospitals. Journal of Education and Practice, 6(27), 50-60.

ISSN 2222-288X

Chaghari, M., Saffari, M., Ebadi, A., & Ameryoun, A. (2017). Empowering Education: A New Model for In-service Training

of Nursing Staff. Journal of advances in medical education & professionalism, 5(1), 26–32. Retrieved from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5238493/

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 REFERENCES

Johnson, J. K. (2003). Clinical Microsystem assessment. Retrieved from

https://d2l.arizona.edu/d2l/le/content/854111/viewContent/8098839/View

Kreitzer, M. J. (2015). Integrative nursing: Application of principles across clinical settings. Rambam Maimonides Med J,

6(2), e0016.

Lacroix, D. (2020). Management and leadership [PowerPoint slides]. Retrieved from

https://d2l.arizona.edu/d2l/le/content/854111/viewContent/8432037/View

Sfantou, D., Laliotis, A., Patelarou, A., Pistolla, D. S.-, Matalliotakis, M., & Patelarou, E. (2017). Importance of Leadership

Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review. Healthcare, 5(4), 73. doi:

10.3390/healthcare5040073

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