Healthcare Delivery Systems

Improvement Project

Cynthia Quinonez
April 20, 2016

Overview of Patient Care Delivery System

X Hospital
X unit
o 40 bed unit
o Nurse patient ratios of 5:1 6:1
o 80% of patients are post-op
o 10% of patients are post-op from laparoscopic
surgery
o 10% are cancer patients
Focus: Information and information technology
Carondelet Health Network. (2015). Orthopedic care. Retrieved from

http://www.carondelet.org/services/orthopedic-care.aspx
Johnson, J. K. (2003). Clinical microsystem assessment tool. Retrieved from
https://d2l.arizona.edu/d2l/le/content/467633/viewContent/3724145/View

Microsystem Model:
Leadership

"Leaders maintain consistency of purpose, establish

clear goals and expectations, and foster a respectful
positive culture. Leaders take time to build
knowledge, review and reflect, and take action
about microsystems and the larger organization."
Democratic leadership
Decentralized decision making
RN feedback respected

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

https://d2l.arizona.edu/d2l/le/content/467633/viewContent/3724145/View
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing. (8th edition).
Philadelphia, PA: Wolters & Kluwer.
3

Microsystem Mode
Organizational Culture and Support

"Recognition, information, and resources that

enhance the nurse's work and make it easier for
the nurse to meet the needs of the patient."
o Educational support and training
o Interdisciplinary support
o Respect and validation among hierarchies
and disciplines

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

https://d2l.arizona.edu/d2l/le/content/467633/viewContent/3724145/View

Microsystem Model:
Patient Focus & Staff Focus

Patient Focus
oMission "to embrace the whole person, in mind, body,
and spirit; and to serve all people with dignity"
(Carondelet Health Network, 2016).
oPatient-centered care: nurses and resources

Staff Focus
o"This is evident through staffing, education and training,
workload, and professional growth"
oMonthly mandatory training
Johnson, J. K. (2003). Clinical microsystem assessment tool. Retrieved from
https://d2l.arizona.edu/d2l/le/content/467633/viewContent/3724145/View
oVarious programs/benefits for staff
Carondelet Health Network. (2015). Mission, vision & values. Retrieved from

http://www.carondelet.org/about/mission-vision-%20values.aspx
Carondelet Health Network. (2015). RN careers. Retrieved from http://www.carondelet.org/about/careers/rn5
%20%20careers.aspx

Microsystem Model:
Interdependence of Care Team

"Care is provided by a interdisciplinary team

characterized by trust, collaboration, appreciation
of complementary roles, and a recognition that all
contribute individually to a shared purpose."

In X unit interdisciplinary team works effectively

o Communication
o Doctors, nurses, medics, pharmacy, RT, PCT,
PT, etc.

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

https://d2l.arizona.edu/d2l/le/content/467633/viewContent/3724145/View

Microsystem Model:
Use of Information and Healthcare Technology

Integration of information with patients

o Patients are given information in a variety of
ways
Integration of information with staff
o Most of the time information is available
o Tedious to look for the information
Integration of information with technology
o It helps but doesn't make the job easier
o Time-consuming

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

https://d2l.arizona.edu/d2l/le/content/467633/viewContent/3724145/View

Microsystem Model:
Process for Healthcare Delivery Improvement

Benchmarking the process of measuring

products, practices, and services against
best-performing organizations

Improvement project implemented

o 4Ps potty, pain, position and possessions
o Aim to decrease the fall percentage
o No falls for 3 months

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing
theory and application. (8th edition). Philadelphia, PA: Wolters & Kluwer.8

Microsystem Model:
Staff Performance Patterns

"Outcomes are routinely measured, we feed data

back to staff, and we make changes based on
data."
o CAUTIs
o Falls
o Pressure ulcers
Staff evaluations

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

https://d2l.arizona.edu/d2l/le/content/467633/viewContent/3724145/View

Specific Aspect Targeted for Improvement

Information Technology
Concurrent use of electronic records and paper
documentation
Inconsistencies with physician orders
Literature states:
o Frequency of documentation is higher in electronic
records vs paper-based records
o Electronic records contained more information
including assessment forms
Goal: Eliminate paper documentation to improve
interdisciplinary communication and patient care.

Wang, N., Yu, P., & Hailey, D. (2013). Description and comparison of documentation of nursing
assessment between paper-based and electronic systems in Australian aged care 10
homes.
International Journal of Medical Informatics, 82, 789-797.

Leading the Plan for Healthcare Delivery

Improvement

Plan: switch over to solely electronic charting

According to the literature, electronic documentation
systems can improve the quality of: documentation
structure and format, the process and content in the
aspects of quantity, and the comprehensiveness and
signing and dating of assessment forms
One year timeline

Morale
1-2mos

Education
4-7mos

Evaluation
7-9mos

House-wide
12mos

Wang, N., Yu, P., & Hailey, D. (2013). Description and comparison of documentation of nursing
assessment between paper-based and electronic systems in Australian aged care homes.
International Journal of Medical Informatics, 82, 789-797.
11

References

Carondelet Health Network. (2015). Mission, vision & values.

Retrieved from http://www.carondelet.org/about/mission-vision%20values.aspx
Carondelet Health Network. (2015). RN careers. Retrieved from
http://www.carondelet.org/about/careers/rn- %20%20careers.aspx
Johnson, J. K. (2003). Clinical microsystem assessment tool.
Retrieved from
https://d2l.arizona.edu/d2l/le/content/467633/viewContent/3724
145/View
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and
management functions in nursing theory and application. (8th
edition). Philadelphia, PA: Wolters & Kluwer.
12

References

Wang, N., Yu, P., & Hailey, D. (2013). Description and comparison of
documentation of nursing
assessment between paper- based
and electronic systems in Australian aged care homes.
International Journal of Medical Informatics, 82, 789- 797.

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