Healthcare Delivery

Systems Improvement
Project – Patient Focus
Aspect
Rachel Eberle
E m i l y Fa u l k
L e x i R o c ke n b a u g h
Mary White
 Overview of Patient Delivery Care
System
• Banner University Medical Center
Tucson
• 7 West Progressive Care Unit
• Focus: Improving patient focus by
decreasing time spent charting

Nelson, E.C., Bataldan, P.B., Huber, T.P., Mohr, J.J., Godfrey, M.M., Headrick, L.A., & Wasson, J.H. (2002).
Microsystems in health care: Part 1. Learning from high-performance front-line clinical units. Joint
Commision Journal on Quality Improvement, 28(9), 472-493. Retrieved from 2
https://www.ncbi.nlm.nih.gov/pubmed/12216343
 Microsystem Model: FR
Leadership

Servant Leadership
• Servant Leaders: leaders who are concerned with others’ needs more than
their own, placing employees, customers, and the community first

• One person for both roles of Nurse Manager and Charge RN

• Promotion of collaboration, teamwork, collective activism

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 65). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.ter 3
 Microsystem Model: FR
Organizational Culture and Support
Organizational Culture
• Values, beliefs, behaviors that members of a unit have in common

Support
• Bed Report
• House Supervisor
• SWAT
• Change of shift huddle

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 306). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins. 4
 Microsystem Model: FR
Patient Focus & Staff Focus & IN Principle
Patient Focus Staff Focus
• Patient and Family-Centered Care: • An environment where employees feel
patient care is organized around the valued, understand what is expected of
needs of the patient. Healthcare them, know how their work contributes
providers communicate effectively to the organization, and have freedom to
with patients and family members to make choices about their work without
empower them to be effective management permission.
partners in their health-care decision
making.
Integrative Nursing
Principle #4: Integrative nursing is person-centered and relationship-based
Kreitzer, M.J. (2015). Integrative nursing: Application of principles across clinical settings. Rambam Maimonides Medical Journal, 6(2). doi: [10.5041/RMMJ.10200]
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 476-477). Philadelphia: Wolters Kluwer
5
Health/Lippincott Williams & Wilkins.
 Microsystem Model: FR
Interdependence of Care Team
Multidisciplinary team working together to achieve a common
goal or plan of care.
• Effective teamwork may benefit the patient by “improving health
outcomes and quality of care… reduced medical errors”
• Physicians rounding includes the nurses; nurses and PCTs collaborate
• Communication through multiple channels
• Team benefits include:
• Promotes trust/willingness to help among staff
• Improved coordination of care
Babiker, A., El Husseini, M., Al Nemri, A., Al Frayh, A., Al Juryyan, N., Faki, M. O., Assiri, A., Al Saadi, M., Shaikh, F., … Al Zamil, F. (2014). Health care professional development:
Working as a team to improve patient care. Sudanese Journal of Pediatrics, 14(2), 9-16.
Nelson, E.C., Bataldan, P.B., Huber, T.P., Mohr, J.J., Godfrey, M.M., Headrick, L.A., & Wasson, J.H. (2002). Microsystems in health care: Part 1. Learning from high-performance
front-line clinical units. Joint Commission Journal on Quality Improvement, 28(9), 472-493. 6
 Microsystem Model: FR
Use of Information and Healthcare Technology
Technology facilitates improved patient safety, healthcare delivery,
and connection of multidisciplinary teams.
• Utilizes computer charting/technology to provide current updates
• Better management of care by shared information through Cerner
• Easy input of orders; immediate lab results
• Possibility of technology getting in the way of patient care
• “Although the information environment has been designed to support
the work of the clinical unit, it may be putting patients at risk for errors
or not having basic needs met”
Bowles, K. H., Dykes, P., & Demiris, G. (2015). The use of health information technology to improve care and outcomes for older adults. Research in Gerontological Nursing,
8(1), 5-10.
Nelson, E.C., Bataldan, P.B., Huber, T.P., Mohr, J.J., Godfrey, M.M., Headrick, L.A., & Wasson, J.H. (2002). Microsystems in health care: Part 1. Learning from high-performance
front-line clinical units. Joint Commission Journal on Quality Improvement, 28(9), 472-493. 7
 Microsystem Model: FR
Process for Healthcare Delivery Improvement

What are the ways to study, measure and improve health care delivery?
• New ways to connect with the patients and improve delivery/access to care

• Patient Satisfaction Survey

• VOICE Annual Survey

• Conversion to Cerner to monitor and study data

Nelson, E.C., Bataldan, P.B., Huber, T.P., Mohr, J.J., Godfrey, M.M., Headrick, L.A., & Wasson, J.H. (2002). Microsystems in health care: Part 1. Learning from high-performance
front-line clinical units. Joint Commission Journal on Quality Improvement, 28(9), 472-493. 8
 Microsystem Model: FR
Staff Performance Patterns
Focuses on patient outcomes and streamlining delivery of care by
frequently collecting data and implementing that data back into
improvements on the unit

• On 7W Progressive Care Unit:

• Monitoring patient falls/bed alarms

• Tracking CAUTIs

• Monitoring patient skin breakdown

Nelson, E.C., Bataldan, P.B., Huber, T.P., Mohr, J.J., Godfrey, M.M., Headrick, L.A., & Wasson, J.H. (2002). Microsystems in health care: Part 1. Learning from high-performance
front-line clinical units. Joint Commission Journal on Quality Improvement, 28(9), 472-493.
9
 Patient Focus: FR
Specific Aspect Targeted for Improvement
and Integrative Modality
• Patient focus should be the primary • Increasing the efficiency of nurses’
concern in their charting will increase their
• Charting on a new system takes ability to prioritize their patients’
away from patient focus needs above anything else
• Adjustment period • Implement strategies using
multiple approaches and
• Frustration with change
educational tools
• Each nurse not set up to succeed
• Under utilization of “super-users”
Colligan, L., Potts, H.W.W., Finn, C.T., & Sinkin, R.A.(2015). Cognitive workload changes for nurses transitioning from a legacy system with paper documentation to a
commercial electronic health record. International Journal of Medical Informatics, 84, 469-476. http://dx.doi.org/10.1016/j.ijmedinf.2015.03.003
Zadvinskis, I. M., Chipps, E., & Yen, P. (2013). Exploring nurses’ confirmed expectations regarding health IT: A phenomenological study. International Journal of Medical
Informatics, 83, 89-98. http://dx.doi.org/10.1016/j.ijmedinf.2013.11.001 10
 Patient Focus: FR
Specific Aspect Targeted for Improvement and
Integrative Modality (cont.)
Integrative Nursing Principle 4- Integrative nursing is person-centered and
relationship-based

• Increasing efficiency of nursing charting would…

• Increase authentic listening – primary modality
• Make it easier to get to know
• Allow the nurse to focus on a healing intention
• Anticipate patient’s needs and preferences

Kreitzer, M.J. (2015). Integrative nursing: Application of principles across clinical settings. Rambam Maimonides Medical Journal, 6(2). doi: [10.5041/RMMJ.10200]
11
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Leading the Plan for Healthcare
Delivery Improvement
M a n d a t o r y C e r n e r Ef f i c i e n c y C o u r s e s

• Present improvement project to staff

• Discuss benefits of increasing charting efficiency for both staff and
patients
• Complete mandatory Cerner efficiency course
• Super-users on every floor who are not in ratio
• Super-users on every floor who are in ratio
• Process improvement evaluation and implementation hospital wide
• Train all new hires/travelers once every month moving forward
Nelson, E.C., Bataldan, P.B., Huber, T.P., Mohr, J.J., Godfrey, M.M., Headrick, L.A., & Wasson, J.H. (2002). Microsystems in health care: Part 1. Learning from high-performance front-
line clinical units. Joint Commision Journal on Quality Improvement, 28(9), 472-493. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12216343 12
 FR
Month 1 Month 2 Months 3-6 Month 7 Months 8-12
Meeting to Cerner Cerner Evaluate Make
present super-user super-user effectiveness adjustments
changes to available at schedule on of Cerner as necessary
staff and all times and each shift training with and
pre- is not in and is in post- implement
intervention ratio. ratio. Super- intervention hospital
survey. user is staff survey. wide.
Mandatory announced
Cerner during
efficiency huddle.
course.

13
Questions?
Hint: Ask if it’s Lexi’s birthday
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References
Babiker, A., El Husseini, M., Al Nemri, A., Al Frayh, A., Al Juryyan, N., Faki, M. O., Assiri,
A., Al Saadi, M., Shaikh, F., … Al Zamil, F. (2014). Health care professional
development: Working as a team to improve patient care. Sudanese Journal of
Pediatrics, 14(2), 9-16.
Bowles, K. H., Dykes, P., & Demiris, G. (2015). The use of health information
technology to improve care and outcomes for older adults. Research in
Gerontological Nursing, 8(1), 5-10.
Colligan, L., Potts, H.W.W., Finn, C.T., & Sinkin, R.A.(2015). Cognitive workload
changes for nurses transitioning from a legacy system with paper
documentation to a commercial electronic health record. International Journal
of Medical Informatics, 84, 469-476. http://dx.doi.org/10.1016/j.ijmedinf.
2015.03.003
Add a footer 15
 FR
References
Kreitzer, M.J. (2015). Integrative nursing: Application of principles across clinical settings.
Rambam Maimonides Medical Journal, 6(2). doi: [10.5041/RMMJ.10200]
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in
nursing: Theory and application (9th ed. p. 65). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkinster
Nelson, E.C., Bataldan, P.B., Huber, T.P., Mohr, J.J., Godfrey, M.M., Headrick, L.A., &
Wasson, J.H. (2002). Microsystems in health care: Part 1. Learning from high-
performance front-line clinical units. Joint Commision Journal on Quality
Improvement, 28(9), 472-493. Retrieved from https://www.ncbi.nlm.nih.gov/
pubmed/12216343
Zadvinskis, I. M., Chipps, E., & Yen, P. (2013). Exploring nurses’ confirmed expectations
regarding health IT: A phenomenological study. International Journal of Medical
Informatics, 83, 89-98. http://dx.doi.org/10.1016/j.ijmedinf.2013.11.001
Add a footer 16