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Healthcare Delivery Systems
Improvement Project:
Staff Focus

Grace B., Jenny L., Becca H., Zaira G., Sydney F.
November 15, 2017
Overview of Patient Care Delivery System
Southern Arizona Veterans

Affairs Health Care System
Cardiac Medical-Surgical
Unit
Focus: Staff focus related

to short-staffing and lack of
clearly defined charge
nurse role
Institute of Healthcare Improvements. (2015). Clinical microsystem assessment tool [PDF document]. Retrieved from
http://clinicalmicrosystem.org/wp-content/uploads/2014/07/microsystem_assessment.pdf
2
Microsystem Model:
Leadership
Leaders struggle to find the right balance between

reaching performance goals and supporting and
empowering the staff
Authoritarian leadership
Decentralized Staffing
Effects on patient care
Marquis, B.L., Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and application.
Philadelphia: Wolters Kluwer.
3
Microsystem Model:
Organizational Culture and Support
The larger organization provides recognition,

information, and resources that enhance my work and
makes it easier for me to meet the needs of my
patient
Organizational Culture
Staff was very supportive of each other
Flat Organizational Design
Removal of hierarchical processes
Philadelphia: Wolters Kluwer.
4
Microsystem Model:
Patient Focus & Staff Focus
Patient-Focus: Patient-Centered Care

The VA provides great care to their patients as defined by
their core values of:
Integrity, Commitment, Advocacy, Respect,
Excellence
Staff-Focus: The orientation process is designed to fully

integrate new staff into culture and work role..
VALOR program, tuition reimbursements
Online modules,workshops, conferences
Union representation
U.S Department of Veterans Affairs. (2017 March 13). Southern Arizona VA health care system: About the Southern
Arizona VA health care system. Retrieved from https://www.tucson.va.gov/about/ 5
Microsystem Model:
Interdependence of Care Team
The care approach is interdisciplinary, but we are

not always able to work as an effective team
No interdisciplinary rounds
Most communication with MD is through EMR
and phone calls (most MDs are prompt)
Pharmacist as a resource
6
Microsystem Model:
Use of Information and Healthcare Technology
Integration of information with providers and staff

Most of the time I have information I need, but
sometimes essential information is missing and I
have to track it down
Integration of information with technology
I have access to information that will enhance my
work, but it is not easy to use and seems to be
cumbersome and time consuming
7
Microsystem Model:
Process for Healthcare Delivery Improvement
Root Cause Analysis Process

Committees review unit errors
Veterans are also asked about their hospital
experience
Improvement Projects Implemented
Fall-prevention (staff resistant)
Infection risk prevention (staff receptive)
Marquis, B.L., & Huston, C.J. (2017). Leadership roles and management functions in nursing theory and application.
(8th ed.,pp 547). Philadelphia, PA: Wolters Kluwer. 8
Microsystem Model:
Staff Performance Patterns
We often collect data on the outcomes of the care

we provide and on some processes of care
Nurses complete checklists regarding patient
safety and education
Committees audit and review information
Griffiths, P., Ball, J., Drennan, J., DallOra, C., Jones, J., Maruotti, A., . . . Simon, M. (2016). Nurse staffing and patient
outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper
based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline
development. International Journal of Nursing Studies, 63, 213-225. doi:10.1016/j.ijnurstu.2016.03.012 9
Specific Aspect Targeted for Improvement
Poor staffing: burdens charge nurse

Charge assigned 5-6 patients in addition to charge RN
role
Studies found poor staffing causes:
Higher levels of job dissatisfaction and burnout
Higher mortality rates and adverse outcomes
Increased falls and medication errors
Lower levels of patient satisfaction
Goal: Increase nurses perception of patient safety and
ability to give safe, quality care
outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper 10
Leading the Plan for Healthcare Delivery
Improvement
Plan Goal Timeframe Total Time
Form the team Within 4-8 weeks By week 8 (month 2)
Set the aim Within 2 weeks By week 10 (month 2.5)
Establish measures Within 8-12 weeks By week 22 (month 5.5)
Select changes Within 2 weeks By week 24 (month 6)
Test changes** 8 week cycle(s) x 2 By week 32-40 (month 8-10)
Implement changes** Within 8 weeks By week 48 (month 12)
Spread changes** Within 24 weeks By week 72 (year 1.5)
**step utilizes PDSA cycle
Institute of Healthcare Improvements. (n.d.). How to improve [webpage and links]. Retrieved from
www.ihi.org/resources/Pages/HowtoImprove/default.aspx. 11
Leading the Plan for Healthcare Delivery
Improvement continued...
Presenting project plan to staff

1. Propose project plan to desired team and establish team
2. After finalizing the aim, measures, and changes, present
the plan and the start date to the staff. Allow time for
questions and review of material.
Aim: Increase nurses perception of patient safety and ability
to give safe, quality care by 80% within 8 weeks
Measure: qualitative (pre/post surveys) and quantitative
(% adherence to change)
Changes: Decrease charge nurses patient load & provide
clearly defined list of expectations and duties
www.ihi.org/resources/Pages/HowtoImprove/default.aspx. 12
References
Aiken, L. H., (2011).The Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different
Nurse Work Environments
outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper
based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline
development. International Journal of Nursing Studies, 63, 213-225. doi:10.1016/j.ijnurstu.2016.03.012
www.ihi.org/resources/Pages/HowtoImprove/default.aspx.
Philadelphia: Wolters Kluwer Health.
U.S Department of Veterans Affairs. (2017 March 13). Southern Arizona VA health care system: About the Southern
Arizona VA health care system. Retrieved from https://www.tucson.va.gov/about/
13

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Healthcare Delivery Systems

Southern Arizona Veterans

Focus: Staff focus related

Leaders struggle to find the right balance between

The larger organization provides recognition,

Patient-Focus: Patient-Centered Care

Staff-Focus: The orientation process is designed to fully

The care approach is interdisciplinary, but we are

Integration of information with providers and staff

Root Cause Analysis Process

We often collect data on the outcomes of the care

Poor staffing: burdens charge nurse

Plan Goal Timeframe Total Time

Form the team Within 4-8 weeks By week 8 (month 2)

Set the aim Within 2 weeks By week 10 (month 2.5)

Establish measures Within 8-12 weeks By week 22 (month 5.5)

Select changes Within 2 weeks By week 24 (month 6)

Test changes** 8 week cycle(s) x 2 By week 32-40 (month 8-10)

Implement changes** Within 8 weeks By week 48 (month 12)

Spread changes** Within 24 weeks By week 72 (year 1.5)

**step utilizes PDSA cycle

Presenting project plan to staff

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