Healthcare Delivery

Systems
Improvement Project
Alyssa Abler, Jackson Copper,
Richard Douglas, Sarah Gauthier
Overview of Patient Care Delivery System

Northwest Medical Center

Medical-Surgical Unit

Focus: Staff focus related to the poor staffing ratio of nurses to

patients
Microsystem Model:
Leadership

Democratic Leaders put an “emphasis on the ‘we’ rather than the I and you”.

➢ Overall collaborative approach between leaders/staff

➢ Self-Scheduling by employees
➢ Democratic-leader model
❖ Positive culture
❖ Clear goals and expectations

Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and application (9th Edition,
P.47). Wolters Kluwer. ISBN Number: 9781496349798.
Microsystem Model:
Organizational Culture and Support
The culture of an organization “includes an organization’s expectations, experiences,
philosophy, and values that hold it together”

➢ Daily Operations
❖ Charge RN leads huddle meeting at start of shift
❖ Strong communication
❖ Team-work
➢ Inconsistent Support
❖ Resources lacking
❖ Meetings throughout hospital (staff meetings, hospital-wide meetings)
Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and application (9th Edition,
p.306). Wolters Kluwer. ISBN Number: 9781496349798.
Microsystem Model:
Patient Focus & Staff Focus
Patient Focus: Patient-centered-care is based on the concept that “care should be organized first and
foremost around the needs of patients”.

➢ Patient-Centered Care with inconsistent smooth service flow

➢ Integrative Nursing Principle #4- Integrative Nursing is Person-Centered and Relationship-Based

Staff Focus: “Inadequate staffing in hospitals and nursing homes, and professional nursing organizations
such as the ANA have expressed concern about the effect poor staffing has on nurses’ health and safety
and patient outcomes”.

➢ Poor Staffing Ratios

❖ Strenuous workload
❖ Nurse Burnout

Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and application (9th Edition,
P.364 & 437 ). Wolters Kluwer. ISBN Number: 9781496349798.
Microsystem Model:
Interdependence of Care Team
Interdisciplinary teams “work collaboratively to deliver coordinated patient care”

➢ Patient Overview
❖ Doctor, Charge Nurse, Staff Nurse, Pharmacist
➢ Patient Care Collaboration
❖ Working with other Nurses and Patient Care Technicians to provide care
➢ Availability to Physicians
❖ Accessibility to be able to connect with other staff members
➢ Social Cohesion
❖ Willingness of members to work together to advance

Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and application (9th Edition p.
357). Wolters Kluwer. ISBN Number: 9781496349798.
Microsystem Model:
Use of Information and Healthcare Technology
Information shared through the Internet “allows nurses to access the latest research and best practice information so that
their care can be evidence based.”

“Technology has dramatically changed how nurses communicate and perform their work. Nurses approach and accept
technology as an adjunct to their nursing cognizance and do not question its presence.”

➢ Internet
❖ Access to evidence-based care
➢ Charting Systems
❖ Online documentation of patient care
❖ Extra resources available
➢ Social Media
❖ Enhance practice, education, and research
❖ Possibility of misuse
➢ Human Judgement
❖ Best source

Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and application (9th Edition p.
506 & p. 507). Wolters Kluwer. ISBN Number: 9781496349798.
Microsystem Model:
Process for Healthcare Delivery Improvement
Standards are “a predetermined level of excellence that serves as a guide for practice … Each
organization and profession must set standards and objectives to guide individual practitioners in
performing safe and effective care”

➢ Audits
❖ Evaluates Performance
➢ Staff Evaluations
❖ Given by Leaders (Charge Nurse)
➢ Benchmarking
➢ Staff Meetings and Huddles
❖ Allows for discussion of quality improvement and new standards of care

Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and application (9th Edition p.
616). Wolters Kluwer. ISBN Number: 9781496349798.
Microsystem Model:
Staff Performance Patterns

“An important managerial controlling responsibility is determining how well employees

carry out the duties of their assigned jobs. This is done through performance appraisals,
in which work performance is reviewed.”

➢ Performance appraisals of staff

➢ Medication Scan Percentage between nurses
➢ Alaris pump tracking to verify right medications given

Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and application (9th Edition p.
574). Wolters Kluwer. ISBN Number: 9781496349798.
Specific Aspect Targeted for Improvement
➢ Staff focus: Increasing nurse-patient ratio

➢ Lower death rates

❖ ICU: 9%
❖ Surgical: 16%
❖ Medical: 6%
➢ Lower rates of disease
➢ Lower length of stay
➢ Decrease costs (Shekelle, 2013; Yunmi,
Seon-Ha, & Young, 2016)
Integrative Modality

➢ Intervention: ➢ #4: Integrative Nursing is

❖ ICU-2 person-centered and
❖ Surgical: 3 relationship-based
❖ Medical: 3-4 ➢ More time with patients

(Shekelle, 2013)
Leading the Plan for Healthcare Delivery
Improvement

➢ Empirical-Rational Strategy: Appoint leaders/ get management on board

➢ Presentation of intervention to staff

❖ Provide details of current nurse to patient ratios and risks

❖ Provide new standards for nurse to patient ratios

➢ Hire core staff, travelers, float pools as needed

Timeline of Events
12
8-9 Months

6-7 Months
Months
5-6 Hospital Wide
Months Hire PRN Staff Implementation
2-3 Months Analyze Trial
Trial
1 Month Implementation
Form a
Committee
Assessment of
Current Ratio
References
Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in
nursing: Theory and application (9th Edition). Wolters Kluwer. ISBN Number:
9781496349798.

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing
Management, 20 (1), 32-37. Doi: 10.7748/nm2013.04.20.1.32.e1013

Shekelle, P.G. (2013). Nurse-patient ratios as a patient safety strategy: A

systematic review. Anals of Internal Medicine, 158(5), 404-409. Doi: 10.7326/0003-
4819-158-5-201303051-00007.

Yunmi, K., Seon-Ha, K., & Young, K. (2016). Effect of nurse staffing variation and
hospital resource utilization. Nursing & Health Sciences, 18 (4). Doi:10.1111/nhs.12294.