Healthcare Delivery Systems

Improvement Project
Gillian Fernandez, Megan Malanowski, Rachel Moses,
Winnie Vuong, and Andrea Walsh
Overview of Patient Care Delivery System

● Hospital: Carondelet, St. Joseph’s Hospital

● Unit: Labor & Delivery
○ 18-bed unit
● Focus: Information/Healthcare Technology related to
continuity of care with paper and electronic charting
Microsystem Model: Leadership
● Leaders and Management
○ Charges (CN/CNL),
○ Manager of floor - Lisette Meyer-Johnson
○ Director of WIS - Teresa Anzar
● Respect for leaders and management
○ Collaboration and assistance from managers
● Leadership style: democratic
○ “Democratic leadership, appropriate for groups who
work together for extended periods, promotes autonomy
and growth in individual workers”
Marquis, B. L. & Huston, C. J. (2017). Leadership roles and management functions in nursing:
Theory and application (9th ed.). Philadelphia, PA: Lippincott-Raven Publishers.
 Microsystem Model: Organizational Culture and
Support

5 core values of Carondelet: Quality, Integrity, Service,

Innovation, and Transparency
● Carondelet Culture- Religious Based
● Safety huddle with St. Mary’s
● New Graduate programs
● Coordination of Report between Microsystems
● Nursing Union
Carondelet Health Network. 2016-2019. Mission, vision, and values. Retrieved from https://www.carondelet.org/about/mission-
vision-and-values
 Microsystem Model: Patient Focus and Staff Focus
“Each unit’s care delivery structure should… satisfy the patient,
provide role satisfaction to nurses, allow implementation of the
nursing process, and provide for adequate communication among
health-care providers.”
Patient Focus
● Patient Education
● Focus on patient choices during labor
Staff Focus
● Continuing Education required for all employees
● Proper Staffing leading to appropriate 1:1 ratio
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management function in nursing: Theory and application, (9th ed.
p. 368). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins
Microsystem Model: Interdependence of Care Team
● “We foster a culture of service that values teamwork and
focuses on the needs of others.” -Carondelet Mission, Vision,
and Values
● Good teamwork on unit
● Mutual respect between colleagues
● Anesthesia, obstetricians, laborist, pediatricians, scrub techs,
CRNFA, charge nurse, neonatal transition nurse
● Social workers, chaplain, and lactation consult PRN
● Transfer of care - Triage, NICU, Couplet Care

Carondelet Health Network. 2016-2019. Mission, vision, and values. Retrieved from https://www.carondelet.org/about/mission-
vision-and-values
 Microsystem Model: Use of Information and
Healthcare Technology
● “Electronic patient encounters represent a quantum leap forward
in legibility and the ability to rapidly retrieve information.”
● Mix of online and paper charting
○ Cerner - specialized L&D program
○ Paper charting forms
● Other
○ Prosec infant security system
○ Maternal/fetal monitoring system
○ Vocera
Hoyt, R. (2019). Benefits of switching to and implementing an EHR. Retrieved from https://www.practicefusion.com/health-
informatics-practical-guide-page-1/
Microsystem Model: Process for Healthcare Delivery
Improvement
● Unit Based Council meetings
● Benchmarking
○ “The process of measuring products, practices, and
services against best performing organizations”.
○ Changing from EBL to QBL
● Safety Huddle

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th
ed. p.647 ). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Microsystem Model: Staff Performance Patterns
● “Quality – is at the core of our business and guides our
actions and decisions”.
● Quality Improvement Measures on the unit
● OB EWS and Sepsis Screening Tool
● Staff Performance Appraisals
○ “In performance appraisals, actual performance, not
intent, is evaluated”.
Carondelet Health Network. 2016-2019. Mission, vision, and values. Retrieved from
https://www.carondelet.org/about/mission-vision-and-values

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th
ed. p.647 ). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Specific Aspect Targeted for Improvement

Target: paper and electronic charting

Integrative Principle: Integrative nursing is person-centered

and relationship-based

Integrative Modality Applied: sitting down at the bedside and

helping expecting mothers breathe through contractions
Leading the Plan for Healthcare Delivery Improvement

● Months 1-2: audit and survey

● Months 3-5: electronic charting education
● Months 6-11: electronic charting implemented
● Months 12+: complete use of electronic charting
● Months 15-16: audit and survey previous factors, assess
differences
Leading the Plan for Healthcare Delivery
Improvement
Audit/Survey Implement Audit/Survey
Charting
0-2m 6-11m 13-15m

3-5m 12+ m
Staff No Paper
Education Charting
References
Carondelet Health Network. 2016-2019. Mission, vision, and values. Retrieved from
https://www.carondelet.org/about/mission-vision-and-values

Hoyt, R. (2019). Benefits of switching to and implementing an EHR. Retrieved from https://www.practicefusion.com/health-
informatics-practical-guide-page-1/

Marquis, B. L., & Huston, C. J. (2017a). Leadership roles and management functions in nursing: Theory and application (9th
ed. p.647 ). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Marquis, B. L., & Huston, C. J. (2017b). Leadership roles and management function in nursing: Theory and application, (9th
ed. p. 368). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins