Healthcare Delivery Systems

Improvement Project: Organizational

Support

Madison Bardsley, Kevin Cornett, Mariya Isarevich, Rayna McParlane, Michelle

Splaver
12/2/2015

Overview of Patient Care Delivery System

Care Delivery Model: Team Nursing and Multidisciplinary

o STICU at BUMC
o Type of care: Emergent and Critical Care
o Conditions: TBI, GSW, Burns, and MVA
o Services: RT, PT, OT, Case Management, Social Work
o 20 beds
o Nurse to patient ratio

1:1 or 1:2

Microsystem Model:
Leadership

Nursing leadership includes Clinical Nurse Leader and Nurse

Manager
Leadership positively influences care
o
o
o
o
o
o
o

Ensures the staff has equipment needed

Teamwork encouraged through nurse rounds
Mandates and encourages ongoing education
Equal opportunity/work environment
Empowers nurses
Holds nurses accountable
Strives for constant improvement of unit

Why is strong leadership important?

o Studies show that positive leadership, such as relational leadership,
results in improved patient outcomes (Wong, Cummings &
3
Ducharme, 2013).

Microsystem Model:
Organizational Culture and Support

Currently there is a basic patient

organization form, but not
evidence-based or standardized
This leads to inconsistencies
when transferring patients
Banner supports this unit
through:
o Providing resources to
succeed, CEUs, recognition of
nurses, promoting team
environment
4

Microsystem Model:
Patient Focus & Staff Focus

Patient Focus
o Implementation of individualized care
o Leadership rounds and check patient/family satisfaction
o Committed to exceptional patient care

Staff Focus
o
o
o
o
o

Continuing education
Collaborative patient assignment process
Staff support with complex patients
Importance of staff wellbeing/debriefing (Keene, et al., 2010).
Voices are heard

Microsystem Model:
Interdependence of Care Team

Interdisciplinary teamwork
supporting patient-centered
care
o Clear and receptive
o
o
o
o

communication
Universal respect and trust
Interdisciplinary collaboration
Valuing specific roles of each
individual
Overall improves patient care
outcomes and patient
satisfaction (Wen & Schulman,
6
2014)

Microsystem Model:
Use of Information and Healthcare Technology

Integration of information with patients

o Patient education, family education, language translation

resources, My Chart

Integration of information with providers and staff

o EPIC, cellphones/pagers, physician/resident available on

unit, pre-shift meeting

Integration of information with technology

o EPIC, Pyxis, patient barcode scanning, online policies,

electronic EKG

Microsystem Model:
Process for Healthcare Delivery Improvement

Quality improvement activities

o Concurrent Audits occur daily
o Data directly impacts the quality of Pt care
Both the nurse manager and clinical leader are in
charge of these audits
Examples- Catheter Associated Urinary Tract Infection
(CAUTI) and central line audits

Microsystem Model:
Staff Performance Patterns

Concurrent and process

audits to assess compliance
after improvements
o Re-Audits
o Accountability checks
for CNLs performing
audits

Data reported back to

nursing staff
o Individual meetings
o Results publicly posted
9

Specific Aspect Targeted for Improvement

Organization support issue

o Patient handoff during report on Trauma ICU

Patient handoff to Trauma ICU can be unclear

Miscommunication leads to decreased patient outcomes,
quality of care, and safety
Specific problems seen on Trauma ICU

10

Specific Aspect Targeted for Improvement

(cont.)

Pilot of evidencebased, standardized

report tool in Trauma
ICU
o See Handouts!

Goal: Decrease
miscommunication and
consequential errors

11

Leading the Plan for Healthcare Delivery

Improvement

In order to implement our intervention of providing a

standardized shift report we as the unit leader would:
o
o
o
o
o

Month 1- plan intervention and design seminar

Month 2- hold 3 seminars for Trauma ICU staff
Month 3- initiate standardized shift report on the unit
Month 4- Progress report with staff
Month 6- Evaluate intervention

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References
Cresswell,

K. M., Bates, D. W., & Sheikh, A. (2013). Ten key

considerations for the successful implementation and adoption of
large-scale health information technology. Journal of the American
Medical Informatics Association, 20(e1), 9-13.
doi:http://dx.doi.org/10.1136/amiajnl-2013-001684
Jukkala, A.M., James, D., Autrey, P., Azuero, A., & Miltner, R.
(2012). Developing a standardized tool to improve nurse
communication during shift report. Journal of Nursing Care
Quality, 27(3), 240-246. doi: 10.1097/NCQ.0b013e31824ebbd7
Keene, E. A., Hutton, N., Hall, B., & Rushton, C (2010).
Bereavement debriefing sessions: An intervention to support
health care professionals in managing their grief after the death of
a patient. Pediatric Nursing, 36(4), 185-189. Retrieved from
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http://www.medscape.com/viewarticle/729872

References

Lacroix, D. Management, leadership, power and politics [PDF

document]. Retrieved from Lecture Notes Online Website
https://d2l.arizona.edu/d2l/le/content/434224/viewContent/3634
200/View
Marquis, B.L. & Huston, C.J. (2015). Leadership roles and
management functions in nursing. Philadelphia, PA: Wolters
Kluwer Health
UC Irvine Health (2015). Traumatic and critical care surgery
services: Conditions and treatments. Retrieved from
http://www.ucirvinehealth.org/medical-services/trauma-criticalcare-surgery/conditions-treatments/
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References

Wong, C. A., Cummings, G. G., & Ducharme, L.

(2013). The relationship between nursing
leadership and patient outcomes: A systematic
review update. Journal of Nursing Management,
21, 709-724. doi:10.1111/jonm.12116
Wen, J., & Schulman, K. A. (2014). Can team based
care improve patient satisfaction? A systematic
review of randomized control trials. PLoS ONE,
9(7). doi:10.1371/journal.pone.0100603
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