Healthcare Delivery Systems

Improvement Project

Jaclyn Spinelli, Monica Stewart, Brittany Huonker, Emily Heiland, Whitney Bouquet

Overview of Patient Care Delivery System

Leadership: Authoritative
Culture and Support: Team Nursing
Patient/Staff Focus: Patient-Centered Care,
Valued Employees
Interdependence of Care Team: Positive
Information and Healthcare Technology: Lack of
hands free communication
Healthcare Improvement: limited Time, Training
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Staff Performance Patterns: focus on patient

Microsystem Model: Leadership

The leadership style of the Neuro ICU was authoritative. The
leadership struggled to find the appropriate balance between
supporting the staff and achieving performance goals by
having a wide range of responsibilities.
Leadership within the Neuro ICU
o Charge nurse frequently called off the ICU for step-down
unit, brain-attacks and was part of the rapid response team
o Nurse Manager worked with the hospital administration
system and was not a strong presence
(Batalden, Nelson, Mohr, Godfrey, Huber, Kosnik, Ahsling,32008)

Microsystem Mode
Organizational Culture and Support
The Neuro ICU utilized Team Nursing to provide care
(Charge Nurse, PCT, CNA) and provided resources,
information and recognition to empower the nurses to meet
the demanding needs of patients.
Contributions to organizational culture & support:
o Individual recognition of nursing performance in huddle
o Monthly recognition Nurse of the Month
o Positive unit atmosphere & team approach
(Institute for Healthcare Improvement, 2015)

Microsystem Model:
Patient Focus & Staff Focus
Patient Focus: Through patient-centered care, the unit is
effective in learning about and meeting patient
preferences, needs, and values.
Staff Focus: Staff members feel that they are valuable
members of the microsystem, but more could be done to
support them.
o High performance expectations
o Continuing education requirements
(Institute for Healthcare Improvement, 2015)

Microsystem Model:
Interdependence of Care Team
Nursing care is provided effectively by an
interdisciplinary team.
The interaction of the staff members is characterized by:
o Collaboration
o Willingness to help each other
o Support
o Appreciation of complementary roles
(Institute for Healthcare Improvement, 2015)

Microsystem Model:
Use of Information and Healthcare Technology
Information is THE connector between staff and patients.
A study by Koch et al., found that integrated information
enhances nurses situational awareness and decreases
errors (2012).
Integration of information with:
o Patients: have access to customized information upon
discharge
o Providers and Staff: staff constantly had to track down
essential information
o Technology: no mode of hands free communication 7

Microsystem Model:
Process for Healthcare Delivery Improvement
Required resources on this unit are seldom available to
support improvement work. Improvement activities
performed were in addition to daily responsibilities.
Resources required for process improvement
o Training
o Time
o Financial support
(Institute for Healthcare Improvement, 2015)

Microsystem Model:
Staff Performance Patterns
Performance focuses on patient outcomes, costs,
streamlining delivery, using data feedback, positive
competition, and discussions about performance. Data is
often collected on the outcomes of the care provided and
on various processes of care
Performance Results
o Patient outcomes/streamlining
o Avoidable costs
o Performance discussions
(Institute for Healthcare Improvement, 2015)

Specific Aspect Targeted for Improvement

Information Technology
Need for improvement based off of personal observation
and nurse interviews
Implement wireless technological communication
Nurses not able to contact charge/each other wirelessly
Charge communicates with step-down unit staff via
Vocera (hands-free communication badge)
Study: Vocera is flexible, mobile, easy, decreases
interruptions, saves time, preferred over phone and
pager
(Richardson & Ash, 2008).

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Leading the Plan for Healthcare Delivery

Improvement
69% of accidental deaths and serious injuries in
hospitals are linked to not being able to communicate
$12 billion wasted annually in U.S. hospitals as result of
communication errors
Plan to stock the neurological ICU with ten Vocera
devices
Present to staff in huddle every shift every other day over
the period of seven days (four sessions)
Part of new staff hiring education
5 minute presentation
(Vocera, 2015)

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References
Batalden P.B., Nelson E.C., Mohr J.J., Godfrey M.M., Huber T.P., Kosnik L., Ashling K. (2008). Microsystems in health care: Part
5. How leaders are leading. Joint Commission Journal on Quality and Safety (6). Retrieved from: http://www.ncbi.nlm.nih.
gov/pubmed/14564748

Institute for Healthcare Improvement. (2015). Clinical Microsystem Assessment Tool. Retrieved from http://www.ihi.
org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
Koch, S. H., Weir, C., Haar, M., Staggers, N., Agutter, J., Grges, M., & Westenskow, D. (2012). Intensive care unit
nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness.
Journal of the American Medical Informatics Association, 19(4), 583-590. Retrieved from http://jamia.oxfordjournals.
org/content/19/4/583.short (slide 7)
Richardson, J. E., & Ash, J. S. (2008). The Effects of Hands Free Communication Devices on Clinical Communication:
Balancing Communication Access Needs with User Control. AMIA Annual Symposium Proceedings, 2008, 621625.
Vocera. (2015). Secure, integrated healthcare communication system. Retrieved from http://www.vocera.
com/microsite/secure-integrated-healthcare-communication?
utm_source=google&utm_medium=cpc&utm_content=vocera%
20communications&utm_campaign=Brand&utm_term=vocera%
20communications&gclid=CJf8rfbwvckCFQyFaQodBzgC1Q

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