HEALTHCARE DELIVERY SYSTEMS

IMPROVEMENT PROJECT

Teresa Brooks, Alex Montenegro, Allysa Neri, Holly Ochieng,

Lizette Rodriguez
November 28, 2018
 OVERVIEW OF PATIENT CARE DELIVERY
SYSTEM

o Banner UMC
o Neuro Med-surg Unit
o Focus: Improve the organizational support of new nurses/new
grads through programs similar to helping hands
 MICROSYSTEM MODEL:
LEADERSHIP

o Servant Leadership: "Listen, keep open mind, no judgement,

serving others, always thinking before reacting".
oHouse supervisor provided unit support
oNurse managers readily available
oCharge nurses in ratio

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application(9th ed. P. 65 ). Philadelphia: WoltersKluwer Health/Lippincott Williams & Wilkins.
 MICROSYSTEM MODE
ORGANIZATIONAL CULTURE AND SUPPORT

• "Management support, collegial influence, and the interaction of

personalities in the work group can have a synergistic effect on
motivation"
oHuddle
oHospital-wide meetings
oDaily change-of-shift reports

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application(9th ed. p.
305). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 MICROSYSTEM MODEL:
PATIENT FOCUS & STAFF FOCUS & IN
PRINCIPLE
• Patient Focus • Staff Focus
oCare coordination o Staff recognition
meetings o Clinical ladder
oPatient rounding
oQ4 Checks
Integrative Nursing Principle: Integrative nursing focuses on the health and
wellbeing of caregivers as well as those they serve

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application(9th ed. P. 364).
Philadelphia: WoltersKluwer Health/Lippincott Williams & Wilkins.
Kreitzer, M. J. (2015). Integrative Nursing: Application of Principles Across Clinical Settings. Rambam Maimonides Medical Journal,
6(2), 1-8. doi:10.5041/rmmj.10200
 MICROSYSTEM MODEL:
INTERDEPENDENCE OF CARE TEAM

• Interdisciplinary teams promote “reduced mortality and

improved quality of life for patients, a reduction in health-care
costs, and a more rewarding professional experience"
oCare coordination
oTeaching hospital dynamics
oRTs, PCTs, PT/OT

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application(9th ed. p. 357). Philadelphia: WoltersKluwer Health/Lippincott Williams & Wilkins.
 MICROSYSTEM MODEL:
USE OF INFORMATION AND HEALTHC ARE
TECHNOLOGY

o Computers in nurses' station and patient rooms

• Computerized charting (Cerner)
o Phones at each computer station
o Ascom and pager system
o Pyxis
o Micromedex
 MICROSYSTEM MODEL:
PROCESS FOR HEALTHC ARE DELIVERY
IMPROVEMENT

Strengths Weaknesses
o2-person checks oCare Coordination
oNarcotic Box oStaffing
oCode Cart
oChaperones
 MICROSYSTEM MODEL:
STAFF PERFORMANCE PATTERNS

o Performance appraisals
o Monthly statistics
oCAUTI
oFalls
o Student evaluations
o DAISY awards
 SPECIFIC ASPECT TARGETED FOR
IMPROVEMENT AND INTEGRATIVE
MODALITY

o Evidence-Based: Caring and Coping: Exploring How Nurses

Manage Workplace Stress
oIdentifying effective coping strategies for workplace stress
oAssessing the availability of organization-based resources
oHospice nurses
• Ways of coping
• Social support
• Organizational resources

Harris, L. J. M. (2013). Caring and coping. Journal of Hospice & Palliative Nursing, 15(8), 446-454. doi:10.1097/NJH.0b013e3182a0de78
 SPECIFIC ASPECT TARGETED FOR
IMPROVEMENT AND INTEGRATIVE
MODALITY (CONT.)

o Organizational support
o Workplace stress among nurses causing burnout, higher
turnover rates, and nursing shortages among many specialties.
o Support from other individuals in the organization has shown to
be most beneficial for nurses.
o Proposed intervention: Utilizing volunteers for 4 hours each day
as a social support system for nurses.
Harris, L. J. M. (2013). Caring and coping. Journal of Hospice & Palliative Nursing, 15(8), 446-
454. doi:10.1097/NJH.0b013e3182a0de78
Labrague, L. J., McEnroe-Petitte, D.M., Leocadio, M.C., Bogaert, P.V., & Cummings, G. G. (2017). Stress and ways of
coping among nurse managers: An integrative review. Journal of Clinical Nursing, 27(1), 1346-
1359. doi: 10.1111/jocn.14165
 LEADING THE PLAN FOR
HEALTHCARE DELIVERY IMPROVEMENT

• .

1 month 3-4 months 5-6 months 9-12 months >1 year

• Staff input • Recruit & train • Implementation • Evaluate • Implement to
volunteers night shift
 REFERENCES

• Harris, L. J. M. (2013). Caring and coping. Journal of Hospice & Palliative Nursing, 15(8),
446-454. doi:10.1097/NJH.0b013e3182a0de78
• Kreitzer, M. J. (2015). Integrative Nursing: Application of Principles Across Clinical
Settings. Rambam Maimonides Medical Journal, 6(2), 1-8. doi:10.5041/rmmj.10200
• Labrague, L. J., McEnroe-Petitte, D.M., Leocadio, M.C., Bogaert, P.V., & Cummings, G.
G. (2017). Stress and ways of coping among nurse managers: An integrative
review. Journal of Clinical Nursing, 27(1), 1346-1359. doi: 10.1111/jocn.14165
• 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 & Wilkins.