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Healthcare Delivery System Improvement Project:

Organizational Support

🙠 Angela
Ashley Baire, Micah Johnson, 🙢 Matthew, Morgan Postal,
and Abbey Spivey

December 4, 2019
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Overview of Patient Care Delivery System

� Banner University Medical Center Tucson


� Clinical Decision Unit (CDU) - Observation
o 20 bed unit, 4:1 ratio (not upheld)

o Patient base
• ETOH/drug withdrawal
• PACU/pre-op/Cath-Lab overflow
• Stable chest pain
• Concussion watch for head injuries
• Psych holds for SI/HI
� Focus: Organizational support related to mandated
nurse-patient ratios
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Microsystem Model: Leadership

� Democratic Leadership - “economic and ego awards are use to


motivate, others are directed through suggestions and
guidance, communication flows up and down...”
o Charge nurse
• Took suggestions from staff (RNs, PCTs)
• Encouraged autonomy and collaboration
� Authoritarian Leadership - “strong control is maintained over
the work group, others are motivated by coercion, others are
directed with commands, communication flows
downwards…”
o Unit manager
• Asked for little feedback from staff
• Dictated unit procedures without involvement
Marquis, B. L., & Huston, C. J. (2017a). Classical views of leadership and management. In Marquis, B. L., &
Huston, C. J. (Eds). Leadership roles and management functions in nursing: Theory and application (9th3
ed., pp. 47). Philadelphia, PA: Wolters Kluwer Health.
Microsystem Model:
Organizational Culture and Support

� Banner has strong organizational culture/support


� “Neglected stepchild of the hospital”
o Lacking in information and resources to

enhance work
• Charge nurse often in ratio
• New grads precept/train
• Supplies and medications in ED
• TELE boxes not readily available
• Lack of PCT when 1:1 psych patients
• No coverage available for RN leaving floor/lunch
o Lack of safe patient ratios

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Microsystem Model:
Patient Focus & Staff Focus

Patient focus: “...philosophy, a process, a model, a concept, and


a partnership that involves both the patient and health care
provider (to include the nurse) arriving at some form of
conclusion about the care and treatment of the patient’s
condition”
Staff focus: “Staffing affects the ability of all nurses to deliver
safe, quality care in all practice settings. By eliminating unsafe
nurse staffing practices and policies, we can provide better health
care for all”
American Nurses Association. (2019). Nurse staffing. Retrieved from
https://www.nursingworld.org/practice-policy/nurse-staffing/

Flagg, A. J. (2015). The role of patient-centered care in nursing. Nursing Clinics of North
America, 50(1), 75-86. https://doi.org/10.1016/j.cnur.2014.10.006 5
Microsystem Model:
Interdependence of Care Team

“...interaction of staff is characterized by trust, collaboration,


willingness to help each other, appreciation of complementary
roles, respect and recognition that all contribute individually to a
shared purpose of patient care.”
� Strong Interdisciplinary Care Team
o Physician Responsive/PCT Receptive

� Close Knit Floor Team


� Strong Communication/Report
o Transition of Patients to other floors

� Wait times between Pharmacy verification


Institute for Healthcare Improvement. (2019). Clinical microsystem assessment tool. Retrieved
from 6
Microsystem Model:
Use of Information and Healthcare Technology

“Technologies such as...e-mail and the internet are


increasing the potential for effective and efficient
communication throughout the organization”
❏ Phones distributed to staff
❏ Use of EHR and IPOC
❏ No computers in rooms
❏ Pyxis downtime during night shift

Marquis, B. L., & Huston, C. J. (2017b). Organizational, interpersonal, and group


communication. In Marquis, B. L., & Huston, C. J. (Eds). Leadership roles and management
functions in nursing: Theory and application (9th ed., pp. 508). Philadelphia, PA: Wolters 7
Microsystem Model:
Process for Healthcare Delivery Improvement:

� “Benchmarking is an important tool that facilitators can use


to motivate a practice to engage in improvement work and to
help members of a practice understand where their
performance falls in comparison to others”

� Benchmarking to compare with other units in the hospital


� Lack of staff meetings and pre-huddle

Agency for Healthcare Research and Quality. (2019). Practice facilitation handbook. Retrieved
from https://www.ahrq.gov/ncepcr/tools/pf-handbook/mod7.html 8
Microsystem Model:
Staff Performance Patterns

� “Performance appraisals let employees know the


level of their job performance as well as any
expectations that the organization may have of them”
o Quarterly
� Clinical ladder program
� Unit performance
o HAP bundle
o Falls
o Length of stay

Marquis, B. L., & Huston, C. J. (2017c). Performance appraisal. In Marquis, B. L., &
Huston, C. J. (Eds). Leadership roles and management functions in nursing: Theory
and application (9th ed., pp. 647). Philadelphia, PA: Wolters Kluwer Health. 9
Specific Aspect Targeted for Improvement

� “From Evidence to Practice: Developing an


Outpatient Acuity-Based Staffing Model”
� Intervention: Charge RNs will utilize a standardized
patient acuity-based assessment tool to determine
staffing for oncoming shift
� Goals
o Adequate nurse staffing
o Reduced nurse burnout
o Increased patient safety
o Higher quality of care
Vortherms, J., Spoden, B., & Wilcken, J. (2015). From evidence to practice: Developing an
outpatient acuity-based staffing model. Clinical Journal of Oncology Nursing, 19(3), 332-
337. doi: 10.1188/15.CJON.332-337 10
Sample: Patient Acuity-Based Assessment Tool

Kidd, M., Grove, K., Kaiser, M., Swoboda, B., & Taylor, A. (2014). A new patient-acuity tool promotes
equitable nurse-patient assignments. American Nurse Today, 9(3), 4. Retreived from
https://www.americannursetoday.com/wp-content/uploads/2014/03/ant3-Workforce-Management- 11
Acuity-304.pdf
Integrative Principle VI and Integrative Modality

� “Integrative nursing focuses on the health and the


wellbeing of caregivers as well as those they serve”

� Nurses work in high-stress environments, making them


more vulnerable to nurse burnout and stress which
impacts their wellbeing and the care provided to their
patients.

Kreitzer M. J. (2015). Integrative nursing: application of principles across clinical settings. Rambam
Maimonides Medical Journal, 6(2), e0016. doi:10.5041/RMMJ.10200
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Leading the Plan for Healthcare Delivery
Improvement: Implementation of FADE Model
January 1st, 2020
● Focus: Maintaining mandated Nurse-Patient Ratios
● Analyze: An internal systems process analysis will be completed
May 1st, 2020
● Develop: Nurse Manager creates a CDU Patient Acuity System
(PAS) Tool
August 1st, 2020
● Execute: Nurse Manager will educate Charge Nurses>Floor Nurses
October 1st, 2020
● Execute: Intervention will be implemented unit-wide
October 1st, 2021
● Evaluate: Impact evaluation will be performed 13
Agee, J. (2017). Reducing chronic obstructive pulmonary disease 30-day readmissions. JONA: The Journal of Nursing Administration, 47(1), 35–40. doi:
Timeline of Proposed Healthcare Delivery
Improvement & Conclusion

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References

Agency for Healthcare Research and Quality. (2019). Practice facilitation handbook. Retrieved from

https://www.ahrq.gov/ncepcr/tools/pf-handbook/mod7.html

Agee, J. (2017). Reducing chronic obstructive pulmonary disease 30-day readmissions. JONA: The Journal of Nursing

Administration, 47(1), 35–40. doi: 10.1097/nna.0000000000000434

American Nurses Association. (2019). Nurse staffing. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/

Flagg, A. J. (2015). The role of patient-centered care in nursing. Nursing Clinics of North America, 50(1), 75-86.

https://doi.org/10.1016/j.cnur.2014.10.006

Institute for Healthcare Improvement. (2019). Clinical microsystem assessment tool. Retrieved from

http://www.ihi.org/resources/Pages/Tools/ClinicalMicrosystemAssessmentTool.aspx.

Kidd, M., Grove, K., Kaiser, M., Swoboda, B., & Taylor, A. (2014). A new patient-acuity tool promotes equitable nurse-patient

assignments. American Nurse Today, 9(3), 4. Retreived from https://www.americannursetoday.com/wp-

content/uploads/2014/03/ant3-Workforce-Management-Acuity-304.pdf

Kreitzer M. J. (2015). Integrative nursing: application of principles across clinical settings. Rambam Maimonides Medical Journal,
15
6(2), e0016. doi:10.5041/RMMJ.10200
References

Marquis, B. L., & Huston, C. J. (2017a). Classical views of leadership and management. In Marquis, B. L., & Huston, C. J. (Eds).

Leadership roles and management functions in nursing: Theory and application (9th ed., pp. 47). Philadelphia, PA: Wolters

Kluwer Health.

Marquis, B. L., & Huston, C. J. (2017b). Organizational, interpersonal, and group communication. In Marquis, B. L., & Huston, C.

J. (Eds). Leadership roles and management functions in nursing: Theory and application (9th ed., pp. 508). Philadelphia, PA:

Wolters Kluwer Health.

Marquis, B. L., & Huston, C. J. (2017c). Performance appraisal. In Marquis, B. L., & Huston, C. J. (Eds). Leadership roles and

management functions in nursing: Theory and application (9th ed., pp. 647). Philadelphia, PA: Wolters Kluwer Health.

Vortherms, J., Spoden, B., & Wilcken, J. (2015). From evidence to practice: Developing an outpatient acuity-based staffing model.

Clinical Journal of Oncology Nursing, 19(3), 332-337. doi: 10.1188/15.CJON.332-337

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Questions?

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