Healthcare Delivery Systems

Improvement Project
Victoria Begg, Lauren Gray, Samantha Inman,
Sara Laurence, Joanna Tomas

04/17/19

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Overview of Patient Care Delivery System
● Tucson Medical Center
● Medical-Surgical Floor
● Focus:
Patient focus related to
answering call lights in a
timely manner
tmcaz.com

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 Microsystem Model: Leadership
● “Leadership is essential to drive improvements in health care
quality and patient safety, and to lead organizational and
system transformation.” (IHI, 2019a)
● Value compassion, dedication, integrity, and community (TMC,
2019a)

● Patient focus: “We will listen to you, we will care for you and
we will do nothing to you without you.” (TMC, 2019c)
○ “We will reach out as teachers and as leaders” (TMC, 2019a)
● Servant Leadership- those that are “...more concerned with
the needs of other than themselves and lead through their
service” (Marquis & Huston, 2017, p. 65)
Institute for Healthcare Improvement. (2019a). Leadership. Retrieved from http://www.ihi.org/Topics/Leadership/Pages/default.aspx
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 65). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilikins
TMC Healthcare. (2019a). Nursing careers. Retrieved from https://jobs.tmcaz.com/nursing-jobs 3
TMC Healthcare. (2019c). Mission, Vision & Values. Retrieved from https://www.tmcaz.com/about-tmc/mission-vision-and-values
Microsystem Model: Organizational Culture and
Support
● “A system of symbols and interactions unique to each
organization… ways of thinking, behaving, and believing
that members of a unit have in common” (Marquis & Huston, 2017, p.
● 306)
Huddle before every ● Respiratory therapy
shift (includes charge ● Food giveaways
nurse) ● Pet therapy
● Rapid response and ● Volunteers
code teams ● Ben’s Bells
● Child Life Specialists ● “Java with Judy”
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 306).
4
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilikins
 Microsystem Model: Patient Focus
● Patient Focus: “...values, needs, and preferences of the
individual are honored; the best evidence is applied; and the
shared goal is optimal functional health and quality of life” (IHI,
2019b)

○ Warren (2012) states to provide care “that is respectful of

and responsive to individual patient preferences, needs,
and values, and ensuring that patient values guide all
clinical decisions” (Marquis & Huston, 2017, p. 365)
○ “...Nothing to you without you” - TMC Commitment (TMC, 2019c)
Institute ○ Various
for Healthcare therapies
Improvement. (2019b). Person- and and events
family-centered tofrom
care. Retrieved cater individual needs
http://www.ihi.org/Topics/PFCC/Pages/default.aspx
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 365). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilikins 5
TMC Healthcare. (2019c). Mission, Vision & Values. Retrieved from https://www.tmcaz.com/about-tmc/mission-vision-and-values
 Microsystem Model: Staff Focus
● Staff Focus: “Integrative nursing focuses on the health and well
being of caregivers as well as those they serve” (Kreitzer, 2015, p. 5)
○ “Your goals are important to us and we want to empower
you to achieve them” (TMC, 2019a)
○ “The importance of educating and empowering nurses to do
their job efficiently and effectively in an environment that is
nurturing, fun, and exciting.” (TMC, 2019a)
○ “We make sure we provide the necessary support for our
nursing staff to excel.” (TMC, 2019a)
○ Daisy Award & Excellent Care Board
Kreitzer, M. K. (2015). Integrative nursing: application of principles across clinical settings. Rambam Maimonides Med J. 6(2): e0016. doi:
10.5041/RMMJ.10200 6
TMC Healthcare. (2019a). Nursing careers. Retrieved from https://jobs.tmcaz.com/nursing-jobs
 Microsystem Model: Interdependence of Care
●Team
Interdisciplinary teams are used to “...assure
that comprehensive and holistic health care
can be provided to each patient...” (Marquis &
Huston, 2017, p. 354)

● Interdisciplinary rounds at patient bedside

● Hospitalists, case managers, and
pharmacists on unit
● Enough Voceras for everyone, even tmcaz.com

volunteers
●Marquis,Continuity of care; contact with Primary Care
B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p.
7
Physicians via Hospitalists
354). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilikins
 Microsystem Model: Use of Information and
Healthcare Technology
● “...increases the likelihood that staff will be able to find
such resources when they need them and that they are as
up-to-date as possible” (Marquis & Huston, 2017, p. 507)
● Epic training for healthcare workers and students
● Access to Google/Micromedex/UpToDate on computers
● Broken call lights fixed immediately
● IT on-call 24/7
● Tele strips on monitors and can be printed
● Vocera
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and https://www.planetheadset.com/Vocera. 8
application (9th ed. p. 507). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilikins php
 Microsystem Model: Process for Healthcare
Delivery Improvement
● “...the process of quality control must be ongoing; that is, it
must reflect a belief that the search for improvement in
quality outcomes in continuous and that care can always be
improved”(Marquis & Huston, 2017, p. 612)
● Quality Alert - reviewed periodically
○ Goals/improvement board
● Collaboration with Abacus Health to “improve patient
experience, improve population health and control costs.” (TMC,
2019b)
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 612). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilikins 9
TMC Healthcare. (2019b). Collaborations. Retrieved from https://www.tmcaz.com/about-tmc/collaborations/
 Microsystem Model: Process for Healthcare
Delivery Improvement cont.
● Mayo Clinic Care Network Collaboration
○ Access to information and physicians through Mayo
Clinic (“AskMayoExpert” Application) (TMC, 2019b)
● Surveys upon discharge
● The Leapfrog Group scores the hospital each year on
Hospital Safety
○ Measures patient injuries, medical errors, medication
errors, and infections (The Leapfrog Group, 2019)
TMC Healthcare. (2019b). Collaborations. Retrieved from https://www.tmcaz.com/about-tmc/collaborations/
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The Leapfrog Group. (2019). About Us. Retrieved from http://www.leapfroggroup.org/ratings-reports
 Microsystem Model: Staff Performance Patterns
● “Performance appraisals are used to determine how well
employees are performing their job. Therefore, appraisals
measure actual behavior and not intent” (Marquis & Huston, 2017, p.
668)

● Monthly rounds of RNs with nurse manager

● Yearly performance appraisals
● Tracking pressure ulcers, CAUTIs, VAPs, and medication
errors each day
● Dual skin check, double verify medications
● B.Staff-voted
Marquis, nurserolesof
L., & Huston, C. J. (2017). Leadership and the month
management functions in
nursing: Theory and application (9th ed. p. 668). Philadelphia: Wolters Kluwer
https://advancesystems.ie/find-right-staff-performance-
11
Health/Lippincott Williams & Wilikins management-software/
 Specific Aspect Targeted for Improvement
● Improving Patient Focus
○ Increasing response time for call lights
● Increased responsiveness of staff leads to higher patient
satisfaction and improvements in patient safety
○ Decreases falls
○ Better pain control
○ Less miscellaneous alarms disturbing patients and
staff
●J. J.Nursing
Nelson, is person-centered
& Staffileno, B. A. (2017). and
Improving the patient experience: Call light relationship-based
intervention bundle. Journal of Pediatric Nursing, 36, 37-43. doi:
10.1016/j.pedn.2017.04.015
Kreitzer, M. K. (2015). Integrative nursing: application of principles across clinical settings. Rambam Maimonides Med J. 6(2): e0016. doi: 12
Specific Aspect Targeted for Improvement

1. Nurse
2. Buddy
Nurse
3. All available
staff

Nelson, J. J. & Staffileno, B. A. (2017). Improving the

patient experience: Call light intervention bundle.
Journal of Pediatric Nursing, 36, 37-43. doi:
13
10.1016/j.pedn.2017.04.015
Leading the Plan for Healthcare Delivery
Improvement
● Four aspects:
○ Staff education regarding importance of call lights on
patient safety
○ Set a goal time: answer call lights within 3 minutes
○ Assign a “pod buddy” at the beginning of each shift
○ Purposeful Rounding

Nelson, J. J. & Staffileno, B. A. (2017). Improving the patient experience: Call light intervention bundle. Journal of Pediatric Nursing, 36, 37-
43. doi: 10.1016/j.pedn.2017.04.015 14
 Timeline

Institute for Healthcare Improvement. (2017). Science of improvement: Testing changes. Retrieved from
http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChanges.aspx 15
Questions?

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References
Institute for Healthcare Improvement. (2017). Science of improvement: Testing

changes. Retrieved from

http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTes

ting

Changes.aspx
Institute for Healthcare Improvement. (2019a). Leadership. Retrieved from

http://www.ihi.org/Topics/Leadership/Pages/default.aspx
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Institute for Healthcare Improvement. (2019b). Person- and family-centered care.
Retrieved from http://www.ihi.org/Topics/PFCC/Pages/default.aspx
Kreitzer, M. K. (2015). Integrative nursing: application of principles across clinical
settings. Rambam Maimonides Med J. 6(2): e0016. doi:
10.5041/RMMJ.10200
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management
functions in
nursing: Theory and application (9th ed.). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilikins
Nelson, J. J. & Staffileno, B. A. (2017). Improving the patient experience: Call light
intervention bundle. Journal of Pediatric Nursing, 36, 37-43. doi: 18
The Leapfrog Group. (2019). About Us. Retrieved from

http://www.leapfroggroup.org/ratings-reports

TMC Healthcare. (2019a). Nursing careers. Retrieved from

https://jobs.tmcaz.com/nursing-jobs

TMC Healthcare. (2019b). Collaborations. Retrieved from

https://www.tmcaz.com/about-tmc/collaborations/

TMC Healthcare. (2019c). Mission, Vision & Values. Retrieved from

https://www.tmcaz.com/about-tmc/mission-vision-and-values

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