Healthcare Delivery Systems

Improvement Project: Staff Focus

 
Janae Benson, Jenna Bojorquez, Nicole Donos, Krista Laurie, Hillary Viswanathan
April 17, 2018

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Overview of Patient Care Delivery System

o Banner University Medical Center Tucson, AZ

o Surgical Trauma Intensive Care Unit
o Focus: Quality Improvement Project with a
Staff Focus
• Extending the current new nurse orientation to
a 6 month nurse residency program.

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Microsystem Model:
Leadership

 Quantum Leadership Model

o “This theory builds on transformational leadership
and suggests that leaders must work together with
subordinates to identify common goals, exploit
opportunities, and empower staff to make decisions
for organizational productivity to occur.”
 Overall supportive and involved

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory
and application (9th ed. p. 72). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
3
Microsystem Mode
Organizational Culture and Support

 Banner University Medical Center values,

“People above all by treating those we serve
and each other with compassion, dignity and
respect.”
 Strive to have a culture based on excellence and
results.
o Support, collaboration and communication
between all ICU.
o Interdisciplinary meetings.

Banner Health (2016). Compliance Hand Book. Retrieved from

https://www.bannerhealth.com/about/mission
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Microsystem Model:
Patient Focus & Staff Focus

 Patient Focus
o “We exist to make a difference in people’s lives
through excellent patient care.”

 Staff Focus
o Educational opportunities provided and paid for.
o Self-scheduling.
o Benefits.

Banner Health (2016). Compliance Hand Book. Retrieved

fromhttps://www.bannerhealth.com/about/mission 5
Microsystem Model:
Interdependence of Care Team

“Communication
 forms the core of management
activities and cuts across all phases of the
management process. It is also the core of the
nurse-patient, nurse-nurse, and nurse-physician
relationship.”

Characteristics
 of STICU interdisciplinary team
oGood interdisciplinary work between nurses, respiratory
therapy and PCTs.
oPhysicians are easily accessible on the unit.
oDistinct lack of an interdisciplinary relationship with
medical team. 6
Microsystem Model:
Use of Information and Healthcare Technology

 “Even the most advanced communication

technology can not replace the human judgment
needed by leaders and managers to use that
technology appropriately.”
 Strengths
o Effective monitoring.
o Useful and accessible electronic resources.
o Barcode scanning inside of patient’s rooms.
 Weaknesses
o Cerner
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory
and application (9th ed. p. 72). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 7
Microsystem Model:
Process for Healthcare Delivery Improvement

 Banner “gathers data from each of their 29

hospitals and measures performance against
national standards to improve patient care.”
 Processes used for Delivery Improvement
o Staff meetings
o Code Debriefing
o Review of Incident Reports
o Quality Control Manager

Banner Health (2018). Banner Health Quality Report. Retrieved from

https://www.bannerhealth.com/about/quality
8
Microsystem Model:
Staff Performance Patterns

 “A performance appraisal wastes time if it is

merely an excuse to satisfy regulations and the
goal is not employee growth.”
 Strengths
o Statistic sharing
o Nursing rounds
 Weaknesses
o Performance appraisals

Marquis, B. L., & Huston, C. J. (2016). Leadership roles and management functions in nursing:
Theory and application (9th ed. p. 651). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins. 9
Specific Aspect Targeted for Improvement

 Evidence based; New Nurse Residency Programs

benefit nurses, patients and hospitals.
 Nurse Benefits
o Reduced stress level and increased job satisfaction.
 Hospital Benefits
o Cost savings.
 Patient Benefits
o Improved safety and outcomes.

Goode, C.J., Reid, P.P, & Sullivan, H.D. (2016). Residency for transition into practice: An essential
requirement for new graduates from basic RN programs. The Journal of Nursing Administration, 46(2).
doi: 10.1097/NNA.0000000000000300

10
Specific Aspect Targeted for Improvement
(cont.)

 Staff Focus
o This unit is a level one trauma intensive care unit
with a 12 week nurse nurse orientation that is
insufficient to build confidence and competence in
nursing care.
 Proposed intervention; Extension of orientation
to a minimum 6 month New Nurse Residency
Program.

Cline, D., La Frentz, K., Fellman, B., Summers, B. & Brassil, K. (2017). Longitudinal outcomes
of an institutionally developed nurse residency program. The Journal of Nursing
Administration, 47(7/8), 384-390. doi:10.1097/NNA.0000000000000500
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Leading the Plan for Healthcare Delivery
Improvement
 Presentation of project to director of nursing.
o Provide evidence based statistical data and research
supporting the transition to a new nurse residency
program using a rational empirical strategy.
 Costs
o A total cost of ~$430,000 per 20 graduate RNs,
annually.
o Average cost to replace 1 RN is $70,000.
o $70,000(20)= $1.4 million
 Education for unit managers and an evaluation of
implementation.
Trepanier, S., Early, S., Ulrich, B. & Cherry, B. (2012). New graduate nurse residency program: A cost-benefit analysis
based on turnover and contract labor usage. Nursing Economic$, 30(4), 207-214. 12
Timeline of Events

12
7 months
months Evalua
6 -
4 months Implemen
Committe ta-tion tion
2 months
e to
1 month months
Presen Educatio create
t to n of residency
Statistic Directo program
al Unit
r of Manager
Analysis Nursin s
g

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References

Banner Health (2018). Banner Health Quality Report.

Retrieved from https://www.bannerhealth.com/about/ quality
Banner Health (2016). Compliance Hand Book. Retrieved
fromhttps://www.bannerhealth.com/about/mission
Cline, D., La Frentz, K., Fellman, B., Summers, B. &
Brassil, K. (2017). Longitudinal outcomes of an
institutionally developed nurse residency program. The
Journal of Nursing Administration, 47(7/8), 384-390.
doi:10.1097/NNA.0000000000000500
Goode, C.J., Reid, P.P, & Sullivan, H.D. (2016). Residency
for transition into practice: An essential requirement for
new graduates from basic RN programs. The Journal of
Nursing Administration. 46(2). doi:
14
10.1097/NNA.0000000000000300
References Continued

Marquis, B. L., & Huston, C. J. (2017). Leadership roles

and management functions in nursing: Theory and
application (9th ed. p. 72). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.
Trepanier, S., Early, S., Ulrich, B. & Cherry, B. (2012). New
graduate nurse residency program: A cost-benefit
analysis based on turnover and contract labor usage.
Nursing Economic$, 30(4), 207-214.
Warren, J.I., Perkins, S. & Greene, M.A. (2018). Advancing
new nurse graduate education through implementation
of statewide, standardized nurse residency programs.
Journal of Nursing Regulation, 8(4), 14-21.

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