Healthcare Delivery Systems:

Interdependence Improvement
Group #3
Charin Begay, Tammy Do, Saran Keita, Francesco Nunez, Boston Richardson
April 14th, 2021
 Tammy

Overview of Patient Care Delivery System

Tucson Medical Center - Tucson, AZ
Mom/Baby Postpartum Unit
● 66-bed unit
● 100s and 300s
● Consists of both antepartum and postpartum moms
● Staff includes RNs (postpartum and lactation), charge
nurse, patient care technicians, unit supervisor,
providers, social workers, birth certificate staff
 Tammy

Microsystem Model:
Leadership
Charge Nurse
● Leadership Style: Laissez-faire
○ Definition: “motivates by support, … does not criticize,
disperses decision making throughout group”
● Helpful, supportive, resource → may be assigned patients
Unit Manager
● Promotes autonomy between unit staff
● Present 8-5 on weekdays, office located on unit
● Assists with discharges if needed
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and
management functions in nursing: Theory and application
(9th ed.). Philadelphia: Wolters Kluwer Health.
 Tammy

Microsystem Model:
Organizational Culture and Support
Culture Support
● Diverse staff ● Beginning of shift
○ Various languages huddle
○ Various medical ● Resources: lactation,
experiences social, L&D, NICU
● “Exceptional care with ● Standard work binders
compassion”

Tucson Medical Center. (2020). Mission, Vision & Values. Retrieved

from https://www.tmcaz.com/about-tmc/mission-vision-and-
values
 Saran

Microsystem Model: Patient & Staff Focus

Patient Focus
● Bedside report
● Cluster care for both newborns and mothers (Theo & Drake, 2017)
● “Primary concern is to meet all patient needs ー listening,
educating, and responding to special requests” (Johnson, 2001)

Staff Focus
● 4 couplets to 1 nurse Johnson, J. K. (2001). Clinical microsystem assessment.
● New graduate contract of 3 years Retrieved from
https://clinicalmicrosystem.org/uploads/documents
● Experienced RNs /microsystem_assessment.pdf
Theo, L. O., & Drake, E. (2017). Rooming-in: Creating a
better experience. The Journal of Perinatal
Education, 26(2), 79–84.
https://doi.org/10.1891/1058-1243.26.2.79
 Saran

Microsystem Model:
Interdependence of Care Team
● Interdisciplinary team focus
● Frequent contact with L&D, NICU, lactation consult,
social services
● Majority of nurses focus on their own patient
assignment

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

https://clinicalmicrosystem.org/uploads/documents/microsystem_a
ssessment.pdf
 Boston

Microsystem Model:
Use of Information and Healthcare Technology
● EPIC EMR
● Computers located in each patient room
○ Nurses encouraged to chart in room when possible
● Voceras given to each nurse
○ Often uncharged
○ Poor signal at nurses station

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

https://clinicalmicrosystem.org/uploads/documents/microsystem_a
ssessment.pdf
 Boston

Microsystem Model:
Process for Healthcare Delivery Improvement
● Skilled nursing tasks require education and certification
○ i.e. BLS and NRP
● Management tracks adherence to charting protocol
○ CHG baths, DV and PPD screenings, co-signing,
and pain assessments
● Beginning-of-shift huddle and mid-shift check ups with
charge

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

https://clinicalmicrosystem.org/uploads/documents/microsystem_a
ssessment.pdf
 Francesco

Microsystem Model:
Staff Performance Patterns
● Performance reports sent via email every 3-4 weeks
● Evaluation focuses on
○ Pain assessments and reassessments
■ Within 29 minutes for PO medications
■ Within 59 minutes for IVP medications
○ CHG bath compliance (once per day)
○ 24-hour genetic newborn screenings
○ Postpartum hemorrhage and preeclampsia
assessments Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
https://clinicalmicrosystem.org/uploads/documents/microsystem_a
ssessment.pdf
 Francesco

Specific Aspect Target for Improvement

Interdependence
● Target
○ Improve interdependence of the healthcare team related to
lack of communication and teamwork
● Intervention
○ Mid-day nurse huddle during the shift to communicate between
nurses
○ Use of SBAR-style communication to keep meeting brief and
address potential problems
Martin, H. A., & Ciurzynski, S. M. (2015). Situation, background, assessment, and
recommendation-guided huddles improve communication and teamwork in
the emergency department. Journal of Emergency Nursing, 41(6), 484–488.
doi:10.1016/j.jen.2015.05.017
 Charin

Integrative Nursing Principle #4

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

● Modality Applied: Team meetings

Rationale: Communication, connection, and collaboration as a
team will promote caring and healthy nurse-patient and nurse-
nurse relationships.

Kreitzer, M. J. (2015). Integrative nursing: Application of principles

across clinical settings. Rambam Maimonides Medical
Journal, 6(2). https://doi.org/10.5041/RMMJ.10200
 Charin

Project Timeline
Implementation
Month 3
●Educate staff
●Conduct mid-
Assessment shift huddles
Month 1
●Arrange meeting
●Staff survey
Evaluation
Month 4
●Post-staff
survey
Plan
Month 2
●Outline speaking
points and goals for
the project
References
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from

https://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). https://doi.org/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.

Martin, H. A., & Ciurzynski, S. M. (2015). Situation, background, assessment, and recommendation-guided huddles improve

communication and teamwork in the emergency department. Journal of Emergency Nursing, 41(6), 484–488.

doi:10.1016/j.jen.2015.05.017
References
Theo, L. O., & Drake, E. (2017). Rooming-in: Creating a better experience. The Journal of Perinatal Education, 26(2),

79–84. https://doi.org/10.1891/1058-1243.26.2.79

Tucson Medical Center. (2020). Mission, Vision & Values. Retrieved from https://www.tmcaz.com/about-tmc/mission-

vision-and-values