Improving Interdependent

 Communication 
Mary Grace DeSilva, Esteban Duarte, Olivia
Duffett, Eric Page, Lynsee Young
December 2nd, 2020
 Overview of Patient Care Delivery System
Northwest Medical Center - Tucson
• Medical-Surgical Unit, a 50-bed unit
• Health care delivery team consists of staff RNs, charge
nurse, PCTs, unit director, unit physician, and specialty
physicians who round.

Issue: ineffective communication between nurses and

physicians regarding roles and responsibilities

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 Microsystem Model: Leadership
Med-Surg Leadership
• Charge RNs give brief handoff to eachother 
• Charge RN leads in a democratic leadership style
• Less controlling, constructive criticism, emphasis on upwards and
downwards communication
• Small authority-power gap promotes autonomy, cooperation, and
coordination
• Unit director available for administrative work and escalation of
issues regarding patients/staff
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from 
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: theory and application (9th  ed, pg. 76, 339). Philadelphia:
Wolters Kluwer Health. 3
 Microsystem Model: Organizational Culture
and Support
Lack of organizational guidance for communication:
• Nurse to nurse bedside report given every shift
• Nurses often do not give report to techs
• Physicians frequently round without nurses' awareness and
most communication occurs via On Page gmail system
• Orders frequently verbalized and physicians unaware of
nurses' scope of practice, ie: discharge orders
• Charge nurses often unaware of arising issues with nurses
• Underutilization of SBAR
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from 
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
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 Microsystem Model: Patient/Staff Focus of
Healthcare Delivery
Staff Culture Overview Patient Focus
• New hires: minimal experience • Total Patient Care Nursing: RN
necessary autonomy with holistic and
• Onboarding: orientation or unfragmented care
preceptorship • Patient education at RN discretion
• Continual Education: ALC  • Care: call light abuse; basic, clustered
• RN staffing ratio of 5:1/3:1 care due to staffing; varied hand-off
• Workload: full admit to discharge • Rounding: 0700/1700 and q1h
• Yearly percentage raises  Johnson, J. K. (2001). Clinical microsystem  assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/m 
icrosystem_assessment.pdf
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and
management functions in nursing: theory and application (9th  ed, pg.
355). Philadelphia: Wolters Kluwer Health.
 Microsystem Model: Interdependence of Care
Team
Collaboration and Communication 
• Full interdisciplinary team
• Teamwork culture: PCT abuse
• Communication: OnPage and phone utilization; "GPS"
tracking; delayed response times and verbal orders
• Holistic care deficit
• Care patterns: PCTs vs. RN best practice

Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from

http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pd
f
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 Microsystem Model: Use of Information and
Healthcare Technology
Integration of Information
• Paging done through Gmail • Charge iPhone
• Cerner EMR • Call RT for EKG’s
• Orders put into Cerner, rarely • Phones in patient rooms
communicated to RN verbally • Careview
• Computers on wheels • Bed view
• Bed alarms and chair alarms
• Vital machines and bladder
scanners are not linked to
Cerner
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pd
f
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 Microsystem Model: Process for Healthcare
Delivery Improvement Activities
Process Improvement
• ALC’s (Advanced • Safety drills
Learning Center) • Chart Auditing
• Skills Fair • Cerner training is
• BLS required available
• ACLS required for • Staff is encouraged to
Charge Nurse continue education
• EKG course • Future and current process
improvements
communicated to staff
during huddle
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pd
f
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 Microsystem Model: Staff Performance
Patterns
Performance Results
• Nurses have yearly reviews with nurse manager (personal
performance)
• Weekly and monthly reviews with charge nurse (floor
performance)
• Benchmarks monitored: Falls, CAUTIs, hand hygiene, length of
stay, readmission, and patient satisfaction
• Benchmarks are available for review in the charge binder and the
unit supervisor's office.
• Results are also posted in the lunch lounge corkboard
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
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 Specific Aspect Targeted for Improvement
Ineffective communication between interdisciplinary team
• Two communication issues: Lack of understanding of role boundaries
and expectations, and ineffective use of unit technology.
• Improvements
• Interprofessional education (IPE)
• Increased communication and time management skills
• Nurses included in patient rounds

Salman, Y. G. & Barr, H. (2018). The effectiveness of interprofessional education in healthcare: A systematic review and meta-analysis.
Wiley Online Library. Retrieved from https://doi.org/10.1016/j.kjms.2017.12.009
Lyndon, M. & Cashell, A. (2017). Collaboration in health care. Journal of Medical Imaging and Radiation Sciences, 48(2), p. 207-216.
Retrieved from https://www.jmirs.org/article/S1939-8654(16)30117-5/pdf 10
 Integrative Nursing Principle
Integrative Nursing Principle #6
● “Integrative nursing is person-centered and relationship-
based.”
● Includes connecting as human beings and developing
staffing patterns that allow continuity of nurse-patient
relationships.

Kreitzer, M. J. (2015). Integrative nursing: Application of principles across clinical settings. Rambam
Maimonides Medical Journal, 6(2). doi: 10.5041/ RMMJ.10200

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 Project Timeline
Months
0-2 3-4 4-5 5-6 6+

Initial planning Begin IPE Modify IPE as Compile data Evaluate IPE.
phase. Consider program. needed. and analyze Decide if
key stakeholders Request Continue IPE. results. Decide outcomes are
and liaisons for ongoing Continue to if IPE is valuable. Share
IPE program. feedback from collect effective. results with other
participants feedback. departments as
for future IPE needed.
sessions.
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 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). do
i: 10.5041/RMMJ.10200
Lyndon, M. & Cashell, A. (2017). Collaboration in health care. Journal of Medical Imaging
and Radiation Sciences, 48(2), p. 207-216. Retrieved from 
https://www.jmirs.org/article/S1939-8654(16)30117-5/pdf
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and  management functions
in nursing: theory and application (9th  ed). Philadelphia: Wolters Kluwer Health.
Salman, Y. G. & Barr, H. (2018). The effectiveness of interprofessional education
in healthcare: A systematic review and meta-analysis. Wiley Online
Library. Retrieved from https://doi.org/10.1016/j.kjms.2017.12.009
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