Healthcare Delivery Systems

Improvement Project

Janelle Westbrook
April 2016

Overview of Patient Care Delivery System

Focus: Performance Results related to use of

personal protective equipment by floor staff

Microsystem Model:
Leadership

Leaders maintain constancy of purpose, establish clear goals

and expectations, and foster a respectful culture. Leaders take
time to build knowledge, review and reflect, and take action about
microsystems and the larger organization (Johnson, 2003).

Democratic staffs are comfortable putting insights about hospital

improvements
Charge Nurse supervise and provide assistance to the staff
during the shift.
Unit Nurse manager- establish goals, ensure that staff have up to
date skills and provide feedbacks to the staff
Clinical Nurse leader- ensure that the unit functions smoothly
Institute for Healthcare Improvement. (2016). Leadership. Retrieved from
http://www.ihi.org/Topics/Leadership/Pages/default.aspx
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing, (8th ed.).

Microsystem Mode
Organizational Culture and Support

Organizational culture is a system of symbols

and interactions unique to each organization. It
is the ways of thinking behaving, and believing
that members of unit have in common. (Marquis
& Huston,2014)
o Very open, nurse supportive of each other
o Morale boost
o Front desk workers

Marquis, B. L., & Huston, C. J. (2012). Leadership Roles and Management Functions in Nursing; Theory
and Application. (7th ed, pp. 268.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Microsystem Model:
Patient Focus & Staff Focus
Patient Focus
o Meet patient needs during care
o Mission is emphasized onto patient care
o Patient advocate representatives
o I CARE principles applied patient care services
o Patient-centered
Staff Focus
o An organization is in charge of contributing to
the growth of staff development programs.
o&Huddle
Marquis, B.L.
Huston, C.J. (2015).
Leadership roles and management functions in nursing theory and application. (8
board
ed. pp. 366). Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins.

th

U.S. Department of Veterans Affairs. (2015). Honoring Veterans. Retrieved from

http://www.tucson.va.gov/features/Honoring_Veterans.asp

Microsystem Model:
Interdependence of Care Team
The care team uses an interdisciplinary approach but is not
always able to work together as an effective team.
o Overall, professional and appropriate
o Nurses helped each other
o PCT were on top of it
o Physicians did daily rounds on patients
Nurse were usually a part of the bed rounding, but not
always
o One physician easily to communicate with and worked well in
the care team
Another physician was not professional
Joseph,
Brown-Manhertz, D.,was
Ikwuazom,
S.,
Singleton, J. (2014) The effectiveness of structured interdisciplinary collaboration for
oR.,Gossiping
a
problem
adult home hospice patients on patient satisfaction and hospital admissions and re-admissions. Joanna Briggs Institute Database of

Systematic Reviews & Implementation Reports 12(7). 148-163.

Johnson, J.K.(2003). Clinical Microsystem Assessment Tool. Retrieved from:
http://clinicalmicrosystem.org/wp-content/uploads/2014/07/microsystem_assessment.pdf

Microsystem Model:
Use of Information and Healthcare Technology

Technology facilitates effective communication

and multiple formal and informal channels are
used to keep everyone informed all the time, listen
to everyones ideas and ensure that everyone is
connected on important topics. (Johnson, 2003)
o CPRS- documentation system
o BCMA (barcode medication administration)

Medication documentation system

o Wander guard
Johnson, J.K.(2003). Clinical Microsystem Assessment Tool. Retrieved from:
http://clinicalmicrosystem.org/wp-content/uploads/2014/07/microsystem_assessment.pdf

Microsystem Model:
Process for Healthcare Delivery Improvement

Supported by the continuous monitoring of

care, use of benchmarking, frequent tests of
change, and a staff that has been
empowered to innovate

Benchmarking used frequently

o Unit aware of standards and will perform
better when watched

Johnson, J.K.(2003). Clinical Microsystem Assessment Tool. Retrieved from:

http://clinicalmicrosystem.org/wp-content/uploads/2014/07/microsystem_assessment.pdf

Microsystem Model:
Staff Performance Patterns

Data is sometimes collected on outcomes of care

and processes of care.
o CNL was in charge of audits, but was not seen

doing these audits

o Never given feedback on results of audits
o Performance depends on individual initiative
Staff was not required to clock in could arrive late
without being noticed
Staff not held accountable for ignoring PPE rules
Institute for Healthcare Improvement (2004). Clinical microsystem action guide: Improving health care by
improving your microsystem. Retrieved from
http://clinicalmicrosystem.org/wp-content/uploads/2014/07/CMAG040104.pdf
Johnson, J.K.(2003). Clinical Microsystem Assessment Tool. Retrieved from:

Specific Aspect Targeted for Improvement

Focus: Staff Performance Patterns

Goal: Improve staff performance patterns with a focus
on increasing compliance of PPE use.
Rationale
o Decreased adherence in Unit

Location of equipment in room

No mask in the room
Equipment runs out easily
Incorrect use of PPE
Inaccurate PPE signs
10

Specific Aspect Targeted for Improvement

(cont.)
Positive Impact on Delivery of Care:
o Decreases Transmission of Infection
o OSHA Mandated
o Protects Healthcare workers and patients
Planned Interventions:
o Continued Training and Education
o Designated Staff RN perform PPE audits
o Publicize audits results
o PPE cart outside the room
o Noticeable
standardized
sign
ofA method
PPEforoutside
room
Beam, E.L., Beckerdite,
M.E., Boulter,
K.C., Gibbs, S.G., Smith, P.W.
(2011).
evaluating health
care workers personal
protective equipment technique. American Journal of Infection Control, 39(5), 415-420. doi: 10.1016/j.ajic.2010.07.009
United States Department of Labor. (2011). Occupational safety and health administration. Retrieved from https://
www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9777
Harris, A.D. et al. (2013). Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU. Journal of American
Medical Association310(15). 1571-1580.

11

Leading the Plan for Healthcare Delivery

Improvement
1-2 months- Establish a committee to assess the staffs levels of
understanding of PPE and compliance
2-3 monthso PPE carts placed outside the room
o New signs introduced into the unit
o Educated on how to properly use signs
o Changes will be discussed during huddle
4-6 monthso CNL will develop an audit sheet
o conduct bi-weekly audits and publicize results
6-8 months- Train unit staff to perform audits and publicize results on
patient care unit
8+ month: Evaluate the interventions with nursing staff input and
Hennessy, K.A. & Dynan, J. (2014). Improving compliance with personal protective equipment use through the model for
12
improvement
staff champions. Clinical
Journal on
of Oncology
Nursing 18(5). 1092-1095.
adjustand
interventions
based
feedback

Questions?!?

13

References

Hennessy, K.A. & Dynan, J. (2014). Improving compliance with

personal protective equipment use through the model for
improvement and staff champions. Clinical Journal of Oncology
Nursing 18(5). 1092-1095
Harris, A.D. et al. (2013). Universal glove and gown use and
acquisition of antibiotic-resistant bacteria in the ICU. Journal of
American Medical Association310(15). 1571-1580.
Institute for Healthcare Improvement (2004). Clinical microsystem
action guide: Improving health care by improving your microsystem.
Retrieved from http://
clinicalmicrosystem.org/wp-content/uploads/2014/07/CMAG040104.p
df
Institute for Healthcare Improvement. (2016). Leadership. Retrieved
from http://www.ihi.org/Topics/Leadership/Pages/default.aspx
14

References

Johnson, J.K.(2003). Clinical Microsystem Assessment Tool. Retrieved

from: http
://clinicalmicrosystem.org/wp-content/uploads/2014/07/microsystem_asses
sment.pdf

Joseph, R., Brown-Manhertz, D., Ikwuazom, S., Singleton, J. (2014) The

effectiveness of structured interdisciplinary collaboration for adult home
hospice patients on patient satisfaction and hospital admissions and readmissions. Joanna Briggs Institute Database of Systematic Reviews &
Implementation Reports 12(7). 148-163.
Marquis, B. L., & Huston, C. J. (2012). Leadership Roles and Management
Functions in Nursing; Theory and Application. (7th ed.). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management
functions in nursing, (8th ed.). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.

15

References

U.S. Department of Veterans Affairs. (2015). Honoring Veterans.

Retrieved from:
http://www.tucson.va.gov/features/Honoring_Veterans.asp
U.S. Department of Veterans Affairs. (2016). Southern Arizona
VA health care system. Retrieved from: http://
www.tucson.va.gov/index.asp
United States Department of Labor. (2011). Occupational safety
and health administration. Retrieved from https://
www.osha.gov/pls/oshaweb/owadisp.show_document?p_tabl
e=STANDARDS&p_id=9777
United States Department of Labor. (2011). Occupational safety
and health administration. Retrieved from: https://
www.osha.gov/pls/oshaweb/owadisp.show_document?p_tabl
e=STANDARDS&p_id=9794
16