Healthcare Delivery Systems

Improvement Project

Audrey Goh, Minli Huang, Bree Junghans. Cynthia Quinonez, Daniela Wallace
April 20, 2016

Overview of Patient Care Delivery System

XY Hospital
XYZ unit
o ## bed unit
o Nurse patient ratios of 5:1 6:1
o 80% of patients are post-op
o 20% are cancer patients

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.

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
o Patient-centered care: nurses and resources

Staff Focus
o "This is evident through staffing, education and training,
workload, and professional growth"
o Monthly mandatory training
o Various programs/benefits for staff

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

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

Microsystem Model:
Interdependence of Care Team

"Care is provided by an interdisciplinary team

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

XYZ 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

7
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.

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
9

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 homes.
International Journal of Medical Informatics, 82, 789-797.

10

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

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

Retrieved from
https://d2l.arizona.edu/d2l/le/content/467633/viewContent/37241
45/View
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and
management functions in nursing theory and application. (8th
edition). Philadelphia, PA: Wolters & Kluwer.
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, 789797.
12