Health System Quality Improvement

Presentation

Rosie Anderson, Leanna Anolin, Anna DeCarlo, Abby Kontich, Olivia Mills
April 17th, 2019

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Overview of Patient Care Delivery System

Southern Arizona Veterans Affair Hospital

Step-down unit
Focus: Interdependence related to lack of
respect between staff members.

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Microsystem Model:
Leadership
Leadership: “The role of leadership for the microsystem is to maintain
constancy of purpose, establish clear goals and expectations, foster positive
culture, and advocate for the microsystem in the larger organization.”
Positives:
o Nurse manager:
• Strong leader and readily available
• Encouraging and supportive
• Servant-Leader Model
• Attends to needs of staff and patients
o Weekly team meeting during huddle

Negatives:
o Inconsistency in charge nurse role
o Lack of respect for charge authority

Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care:
Part 1. Learning from high-performing front-line clinical units. Joint Commission: Journal on Quality Improvement, 28(9), 472-493.

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Microsystem Mode
Organizational Culture and Support
Culture: “There is a pattern of values, beliefs, sentiments, and norms that
reflect clinical mission, quality of staff work life, and respectful patterns of
interpersonal relationships”
Support: “The larger organization provides recognition, information and
resources to enhance and legitimize the work of the microsystem”
Positive
o Flyers, reminders of change in protocols
o Updated educational resources for staff
o Support for homeless veterans and other community resources for this
population
o Larger organization provides educational resources and support to
microsystem
o Culture/mission of caring for veterans was upheld
Negative
o Disrespect between staff members and interpersonal relationships
Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care:
Part 1. Learning from high-performing front-line clinical units. Joint Commission: Journal on Quality Improvement, 28(9), 472-493.

4
Microsystem Model:
Patient Focus & Staff Focus
Patient Focus: “Meet all patient needs– caring, listening, educating, and
responding to special requests; establishing a relationship with community
and other resources”
Staff Focus: “Selective hiring of the right kind of people, integrating new
staff into culture and work roles, and aligning daily work roles with training
competencies”
Positives:
o Staff:
• New grad training
o Patient:
• Always in safe patient ratios
• Low incidence of preventable events (falls)
Negatives:
o Staff:
• Unlikely that nurses are fired after 2 years of employment
Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care:
Part 1. Learning from high-performing front-line clinical units. Joint Commission: Journal on Quality Improvement, 28(9), 472-493.

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Microsystem Model:
Interdependence of Care Team
Interdependence: “The interaction of staff is characterized by trust,
collaboration, willingness to help each other, appreciation of complementary
roles, and a recognition that all contribute individually to a shared purpose”
Positives:
o Utilization of resources (case managers, PT/OT, RT, pharmacy)
o Each patient received a spiritual consult with chaplain
Negatives:
o Lack of respect between charge nurses and staff nurses and nurses
and techs
o Arguments between staff members
o Inconsistency of charge nurse role
o Poor communication between doctors and patients

Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care:
Part 1. Learning from high-performing front-line clinical units. Joint Commission: Journal on Quality Improvement, 28(9), 472-493.

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Microsystem Model:
Use of Information and Healthcare Technology

Information and information technology: “Information is key, technology

smoothes the linkages between information and patient care by providing
access to the rich information environment. Technology can facilitate
effective communication.”
Positives:
o Call lights
o Vocera and pagers
o Access to medical records online through request
o CPRS
Negatives:
o BCMA, pisces, CPRS

Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care:
Part 1. Learning from high-performing front-line clinical units. Joint Commission: Journal on Quality Improvement, 28(9), 472-493.
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Microsystem Model:
Process for Healthcare Delivery Improvement

Process Improvement: “An atmosphere for learning and redesign is

supported by the continuous monitoring of care, use of benchmarking,
frequent tests of change, and a staff that has been empowered to innovate”
Positives:
o Unit council
o Hospital-wide voting for change of a better ”computer on wheels”
o Staff huddle before each shift
o “Yellow Belt”

Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care:
Part 1. Learning from high-performing front-line clinical units. Joint Commission: Journal on Quality Improvement, 28(9), 472-493.

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Microsystem Model:
Staff Performance Patterns
Performance patterns: “Performance focuses on patient outcomes,
avoidable costs, streamlining delivery, using data feedback, promoting
positive competition, and frank discussions about performance.”
Positives:
o VANOD: skin assessment
o Quarterly performance reviews
o Performance cards in patient rooms
o Omnicell: to decrease cost of supplies

Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002).
Microsystems in health care: Part 1. Learning from high-performing front-line clinical units. Joint Commission: Journal
on Quality Improvement, 28(9), 472-493.
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Specific Aspect Targeted for Improvement

INTERDEPENDENCE: lack of respect due to inconsistent charge nurse

Rationale for choice: Anna’s experience during her preceptorship when
working alongside the charge nurse and noticed a lack of trust, collaboration
and helping each other
Integrative principle/modality applied:
o Integrative Principle #4: Integrative nursing is person-centered and
relationship-based.

Eggenberger, T. (2012). Exploring the charge nurse role: holding the frontline. The Journal of Nursing
Administration, 42(11), 502-506.

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Leading the Plan for Healthcare Delivery
Improvement
Goal: Establish a permanent charge nurse leadership position with
interview process and leadership management training
Evidenced Based Intervention:
o University of Colorado Hospital Charge Nurse Leadership Project:
Established a permanent charge nurse leadership position
Implementation:
o Assess current themes and role of charge nurse on unit
o Discuss with staff the need for change within the charge nurse’s role
o Design and implement online application for advanced charge nurse
leadership position with leadership and managerial skill screening
o Select and interview applicants; select 6 charge nurses (3 days; 3
nights)
o Selected charge nurses attend 2-day leadership training program
o Trained charge nurses begin new role on the unit
o Ongoing evaluation with Leadership Practice Inventory (LPI)
Krugman, M. & Smith, V. (2003). Charge nurse leadership development and evaluation. The Journal of Nursing 11
Administration, 33(5), 284-292.
Timeline of Events
References

Eggenberger, T. (2012). Exploring the charge nurse role: holding the frontline. The Journal of Nursing Administration,
42(11), 502-506.

Krugman, M. & Smith, V. (2003). Charge nurse leadership development and evaluation. The Journal of Nursing
Administration, 33(5), 284-292.

Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002).
Microsystems in health care: Part 1. Learning from high-performing front-line clinical units. Joint Commission:
Journal on Quality Improvement, 28(9), 472-493.

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