Healthcare Delivery Systems

Improvement Project

Camille Firestone, Tonya King, Julie Brandt, Megan Deschenes, & Haley McCuen
December 2nd, 2015

Overview of Patient Care Delivery System

The microsystem assessed is a 30-bed adult medicalsurgical Unit

Receives patients admitted for general surgery, from the
emergency room, and directly from various medical offices
(except neurology and telemetry patients).
Patient-to-nurse ratios are - day shift 5:1 & night shift 6:1
o Charge nurse enters ratio when needed
Patient- and family- centered care is provided by a
multidisciplinary healthcare team
The success characteristic of this microsystem we targeted
for improvement is performance patterns, regarding safe
medication delivery.
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Microsystem Model:
Leadership

Distributive leadership is utilized on this unit. The charge

nurses & nurse manager contribute to positive patient
outcomes by assuring a competent workforce, a safe
environment, and stepping in personally to assist staff when
needed.
Leaders influences on patient care:
o Nurse manager: assess patient satisfaction, assures
competence of care/staff, promotes safe/positive
environment, and conducts process improvement projects
o Charge nurses: creates patient assignments, provides
assistance/guidance, conducts safety huddle, promotes
quality/safe patient care, and steps into ratio when needed
o Both assure that patient and family are focus of care

(Perkins, 2013)

Microsystem Model:
Organizational Culture and Support

The units culture embodies the philosophy, mission, and

values of the hospital. This culture is established by
training, leadership, and hiring staff who contribute to a
positive healing environment.
This culture impacts delivery of care because its staff
emanates respect, generosity, compassion, integrity,
dedication, dignity, creativity, wisdom, & evidenced-based
care.
Organizational support is facilitated by unit leaders
communicating staff & patient needs to the nurse
supervisor.
This enables the macrosystem to enhance care delivery by
providing recognition, information, & resources to the unit.

(Foster, Johnson, Nelson, & Batalden, 2007) 4

Microsystem Model:
Patient Focus & Staff Focus

Individual patient needs & evidenced-based practice

recommendations drive the care delivered by the microsystem
Patient- & family-centered care is driven by:
o Individual needs expressed by the patient
o Listening to patient/family perspectives & opinions
o Communicating & educating the patient & family
Staff focus:
o Staff perspectives/perceptions valued by leaders during
huddle & anonymous staff feedback surveys
o Leadership emphasizes units specific vision when hiring,
orienting, educating, retaining & incentivizing staff
(Marquis & Huston, pg. 327, 2014; Nelson et al.,
2002) 5

Microsystem Model:
Interdependence of Care Team

Microsystem healthcare delivery model emphasizes

multidisciplinary team to assure provision of comprehensive
& holistic care
Interdependency, communication, trust, respect, &
appreciation of each members vital role contributes to the
team functioning successfully to achieve positive patient
outcomes
Team supports patient- & family-centered care by:
o Interacting with them during multidisciplinary rounds
o Promoting bedside handoff between nurses
o Developing care plan & making healthcare decisions
through collaboration with patient, family, & staff
o Providing them access to health information & resources
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(Institute for Patient- and Family-Centered Care, 2013; Marquis & Huston,

Microsystem Model:
Use of Information and Healthcare Technology

In a Microsystem, information is the connector between

patients to staff, and staff to staff
Technology facilitates effective communication, through
formal and informal channels used to keep staff and
patients informed all the time
Information and technology used on the unit to support the
functioning of the unit:
o Cerner Electronic Healthcare Record
o Online Web portal for patients
o Computers in every patient room
o Telephone communication
o Intranet & internet access for staff
(Nelson et al., 2002; Wasson, Godfrey, Nelon, Mohr,
&
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Microsystem Model:
Process for Healthcare Delivery Improvement

Improvement process in the microsystem is developed by

the macrosystem the hospital and enforced through
nurse leaders & the educator on the unit
Managers assess for areas of weakness in care delivery
processes gather current outcome measures
develop goals design method to change behaviors
work with staff to implement improvement process
evaluate for effective change in structure, process, &
outcome measures
Process improvement, often implemented through online
training modules & in-person educational courses, is aimed
at enhancing patient care by increasing staff knowledge
and skills
(Melnyk & Fineout-Overholt, 2011) 8

Microsystem Model:
Staff Performance Patterns

The macrosystem's mission & desired performance patterns

influence the quality improvement projects developed by the unit
manager
Performance patterns (and outcomes) evaluated for quality
improvement:
o Chart audits to collect data on documentation of: CHG baths,
fall risk/safety precautions, hourly patient checks, thorough &
timely assessments, etc.
o Unit incident reports with staff responses
o Unitss nosocomial infection rates
o Nurses pre-OR checklist for surgical patients
o Use of various benchmarking information to evaluate processes
and outcomes regarding staff performance
(Nelson et al., 2002)

Specific Aspect Targeted for Improvement

The success characteristic of this microsystem we

targeted for improvement is nursing performance
patterns, regarding safe medication delivery by
reducing IV medication errors.
To target IV med errors, we recommend replacing
existing Hospira Plum A+ infusion pumps with
Carefusion Alaris smart pumps on the Unit
o 1 Alaris pump unit per patient room
o 2 infusion channels per unit
o 10 PCA, SpO2, and Syringe pump modules
available for use
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Specific Aspect Targeted for Improvement

(cont.)

The Alaris pump has several benefits, when

compared to the existing Plum A+ infusion
pumps, that provide innovative solutions to
improve healthcare
o Decrease in medication errors
o Increased safety
o Cost effective
o Easy ambulation
(Care Fusion, 2012; Manrique-Rodriguez et al.,

Leading the Plan for Healthcare Delivery

Improvement

In order to present our proposed plan to the

hospital staff on the medical/surgical unit, a staff
meeting will be held several times throughout a
one week period.
o Printable brochure from Care Fusion
o PowerPoint describing the change and its
benefits
o Alaris pump available for show
o Staff training announcement
o Go live date
(Care Fusion, 2011)
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References

Care Fusion. (2011). Alaris. Great impact on improving medication events in the
shortest amount of time: city of hope case study. Retrieved from: http://
www.carefusion.com/documents/case-studies/infusion/IF_City-of- Hope_CS_EN.pdf
Care Fusion. (2012). Alaris. Protect every patient and infusion every time : guardrails
suir MX software. Retrieved from: http://www.carefusion.com/Documents/
brochures/infusion/IF_Guardrails-Suite-MX-software_BR_EN.pdf
Care Fusion. (2015). Infusion System Devices. Standardize infusion devices to protect
patient care. Retrieved from: http://www.carefusion.com/our-products/infusion/
infusion-system-devices
Foster, T. C., Johnson, J. K., Nelson, E. C., & Batalden, P. B. (2007). Using a Malcolm
Baldrige framework to understand high-performing clinical microsystems. Quality and
Safety in Health Care, 16(5), 334-341. Doi: 10.1136/qshc.2006.020685
Godfrey, M. M., Nelson, E. C., Wasson, J. H., Mohr, J. J., & Batalden, P. B. (2003).
Microsystems in health care: Part 3. Planning patient-centered services. Joint
Commission Journal on Quality and Patient Safety, 29(4), 159-170. Retrieved
from
http://lsatqdm.qdmnet.com/qdm/microsystems/JQIPart3.pdf

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References

Institute for Patient- and Family-Centered Care (IPFCC). (2013). Frequently asked
questions. Retrieved from http://www.ipfcc.org/faq.html
Marquis, B. L. & Huston, C. J. (2014). Leadership roles and management functions in
nursing: Theory and application (8th Edition). Philadelphia: Lippincott Williams and
Wilkins.
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing &
healthcare: A guide to best practice (2nd Edition). Philadelphia: Lippincott Williams &
Wilkins.
Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., &
Wasson, J. H. (2002). Microsystems in healthcare: Part 1. Learning from high
performing front-line clinical units. The Joint Commission Journal on Quality
Improvement, 28(9), 472 493. Retrieved from http://lsatqdm.qdmnet.com/qdm/
microsystems/JQIPart1.pdf
Perkins, K. M. (2013). Investation an original leadership concept. Nursing
management, 44(4), 34-39. doi: 10.1097/01.NUMA.0000428200.29636.5a
Wasson, J. H., Godfrey, M. M., Nelson, E., Mohr, J. J., & Batalden, P. B. (2003).
Microsystems in health care: Part 4. Planning patient-centered care. Joint Commission
Journal on Quality and Patient Safety, 29(5), 227-237. Retrieved from
http://lsatqdm.qdmnet.com/qdm/microsystems/JQIPart4.pdf

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