Healthcare Delivery Systems

Improvement Project

Presenters: Brendan Gibbons,

Spring 2016

Overview of Patient Care Delivery System

Cardiovascular Intensive Care Unit

Focus: Interdependence of Health Care Team
o leadership
o organizational culture & support
o patient & staff focus
o use of information technology
o process for healthcare delivery improvement
o staff performance pattern

Microsystem Model:
Leadership
Creating and fostering the mission and vision of the
organization
Strong leaders act as visionaries that create a course
for the unit for present and future care
Goals are created and sustained by prominent leaders
Teaching occurs by leaders on a micro level between
leaders and staff
Democratic Leadership in CVICU
Huber, T. (2007, May 1). Leadership Skills for Leading Microsystems.
Retrieved from http://www.dhcs.ca.gov/provgovpart/initiatives/nqi/Documents/LeadershipSkills.pdf

Microsystem Mode
Organizational Culture and Support
Excellent organizations encourage positive
interpersonal relationships, whereas poor unit and
organizational culture exacerbates feelings of alienation
Reward and value employees who are achievement
oriented
Ultimately organizational wide support enhances patient
outcomes, better system performance, and improved
professional development
CVICU is a tightly knit community
Wooten, L., & Crane, P. (2003). Medscape. Nurses as Implementers of Organizational Culture.
Retrieved April 18, 2016, from http://www.medscape.com/viewarticle/465920

Microsystem Model:
Patient Focus & Staff Focus
Delivery of Care on this unit is driven by:
Evidence Based Practice
cost effectiveness/maximizing resources
Organization's goals and mission statement
Patient Focus:
patient centered care
Staff focus:
The Cardiac ICU tries to show staff they are valued:
o flexibility in patient assignments
o providing educational opportunities (tuition
assistance)
o opportunities to be on committees for unit changes
o opportunities for professional growth
ASHP Foundation.(2016). Clinical Microsystems. Retrieved from: http://www.ashpfoundation.org/lean/cms_print.html

Microsystem Model:
Interdependence of Care Team
Interdependence refers to the interaction and
relationships between staff members. In an ideal
environment, care is provided by a interdisciplinary team
characterized by trust, collaboration, appreciation of
complementary roles, and a recognition that all
contribute individually to a shared purpose.
Interdependence of Care Team on CVICU
o Reduced staff results in more float nurses
o Loss of experienced nurses
o Lack of trust and collaboration
Institute for Healthcare Improvement. (2003). Clinical microsystem Assessment Tool. Retrieved from:

Microsystem Model:
Use of Information and Healthcare Technology
The strategic use of technology and information can
facilitate effective communication between staff to
patients, staff to staff, needs with actions to meet needs
(Clinical Microsystem Assessment Tool, 2003).

Highly coordinated patient experience

Institute for Healthcare Improvement. (2004) Clinical Microsystem Assessment Action Guide. Retrieved from:
http://clinicalmicrosystem.org/wp-content/uploads/2014/07/CMAG040104.pdf
Weaver, B., Lindsay, B., & Gitelman, B. (2012). Communication technology and social media: Opportunities and implications for
healthcare systems. Online Journal of Issues in Nursing, 17(3), 3. doi:Vol-17-2012/No3-Sept-2012/CommunicationTechnology-Social-Media.html

Microsystem Model:
Process for Healthcare Delivery Improvement
We monitor and measure the treatments our
patients receive and evaluate our performance
against our own rigorous standards as well as
industry benchmarks In the CVICU

oUniversity

HealthSystem Consortium

oQuality & Safety First Program

oShared leadership council, monthly meetings

Microsystem Model:
Staff Performance Patterns
Staff performance is routinely measured, performance
data is communicated back to staff and changes are
implemented according to data (Clinical Microsystem
Assessment Tool, 2003).
Core staff receives monthly check-ins from unit manager
Performance evaluations mid-year and yearly
New staff receive more frequent check-ins from
manager and director
Institute for Healthcare Improvement. (2003). Clinical microsystem Assessment Tool. Retrieved from:

Specific Aspect Targeted for Improvement

Interdependence of the healthcare team
Float nurses vs core staff nurses
o Communication
o Trust and morale
o Cohesiveness and efficiency
The care approach is interdisciplinary, but we are not
always able to work together as an effective team
(Clinical Microsystem Assessment Tool, 2003)
Institute for Healthcare Improvement. (2003). Clinical microsystem Assessment Tool. Retrieved from:
http://clinicalmicrosystem.org/wp-content/uploads/2014/07/microsystem_assessment.pdf

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Specific Aspect Targeted for Improvement

(cont.)
Unit-based Teamwork Improvement Intervention:
TeamSTEPPS designed intervention
Addresses how to improve 5 teamwork strategies:
leadership, communication, situational monitoring, team
structure, and mutual support
Results from Mayer et al., (2011) conclude an
improvement in teamwork and patient care.
Include float nurses and other members of patient care
team
Mayer, C.M., Cluff, L., Lin, W., Willis, T.S., Stafford, R.E., Williams, C.,...Amoozegar, J.B. (2011). Evaluating efforts to optimize
TeamSTEPPS implementation in surgical and pediatric intensive care units. The Joint Commission Journal on Quality
and Patient Safety, 37(8), 365-374.

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Leading the Plan for Healthcare Delivery

Improvement

Plan for Implementation:

oMay 1, 2016- Conduct readiness assessment.
oMay 15, 2016- Introduce TeamSTEPPS.
oMay 30, 2016- TeamSTEPPS group meeting.
Formulate Change team
oJune 15-17, 2016- 2.5 day TeamSTEPPS Master
Training
oJune 30-August 30, 2016- Group training sessions
o1 month, 3 month, 6 month, 12 month postimplementation observational evaluation.

Mayer, C.M., Cluff, L., Lin, W., Willis, T.S., Stafford, R.E., Williams, C.,...Amoozegar, J.B. (2011). Evaluating efforts to optimize
TeamSTEPPS implementation in surgical and pediatric intensive care units. The Joint Commission Journal on Quality
and Patient Safety, 37(8), 365-374.

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References

ASHP Foundation.(2016). Clinical Microsystems. Retrieved from: http://www.ashpfoundation.org/lean/cms_print.html

Bohmer, R. M. (2013). Leading clinicians and clinicians leading. New England Journal of Medicine, 368(16),
1468-1470.
Institute for Healthcare Improvement. (2003). Clinical microsystem Assessment Tool. Retrieved from:
http://clinicalmicrosystem.org/wp-content/uploads/2014/07/microsystem_assessment.pdf
Marquis, B.L. & Huston, C.J. (2014). Leadership roles and management functions in nursing: Theory and application
(8th Edition). Lippincott Williams and Wilkins.

Mayer, C.M., Cluff, L., Lin, W., Willis, T.S., Stafford, R.E., Williams, C.,...Amoozegar, J.B. (2011). Evaluating efforts to
optimize TeamSTEPPS implementation in surgical and pediatric intensive care units. The Joint Commission
Journal on Quality and Patient Safety, 37(8), 365-374.
Huber, T. (2007, May 1). Leadership Skills for Leading Microsystems.

Retrieved from http://www.dhcs.ca.gov/provgovpart/initiatives/nqi/Documents/LeadershipSkills.pdf

Wooten, L., & Crane, P. (2003). Medscape. Nurses as Implementers of Organizational Culture.
Retrieved April 18, 2016, from http://www.medscape.com/viewarticle/465920

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